Provider Demographics
NPI:1508117466
Name:THOMPSON, CANDYCE JAYE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CANDYCE
Middle Name:JAYE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 17TH ST NW UNIT 607
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30363-1239
Mailing Address - Country:US
Mailing Address - Phone:901-262-1337
Mailing Address - Fax:
Practice Address - Street 1:330 PROGRESS CIR STE C
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-6262
Practice Address - Country:US
Practice Address - Phone:678-365-0322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9574122300000X
GADN015788122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist