Provider Demographics
NPI:1407118532
Name:THOMPSON, CALEB LANCE (DDS)
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:LANCE
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 210
Mailing Address - Street 2:350 COURT ST.
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37756
Mailing Address - Country:US
Mailing Address - Phone:423-663-8200
Mailing Address - Fax:
Practice Address - Street 1:350 COURT STREET
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37756
Practice Address - Country:US
Practice Address - Phone:423-663-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9505122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist