Provider Demographics
NPI:1376279968
Name:THOMPSON, RACHEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16707 GEORGE GANG BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46062-6013
Mailing Address - Country:US
Mailing Address - Phone:317-504-1686
Mailing Address - Fax:
Practice Address - Street 1:2935 E 96TH ST STE 100
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1382
Practice Address - Country:US
Practice Address - Phone:317-846-3463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013866A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist