Provider Demographics
NPI:1457667115
Name:MICHAEL L. THOMPSON, MS, DDS, PLLC
Entity Type:Organization
Organization Name:MICHAEL L. THOMPSON, MS, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, DDS, PLLC
Authorized Official - Phone:870-932-0015
Mailing Address - Street 1:2737 PAULA DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-8017
Mailing Address - Country:US
Mailing Address - Phone:870-932-0015
Mailing Address - Fax:870-932-0015
Practice Address - Street 1:2737 PAULA DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-8017
Practice Address - Country:US
Practice Address - Phone:870-932-0015
Practice Address - Fax:870-932-0015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-19
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR28281223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty