Provider Demographics
NPI:1578697595
Name:THOMPSON, JUNIOR SYLVESTER
Entity Type:Individual
Prefix:DR
First Name:JUNIOR
Middle Name:SYLVESTER
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4635 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 700
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7169
Mailing Address - Country:US
Mailing Address - Phone:713-877-0697
Mailing Address - Fax:713-623-8380
Practice Address - Street 1:12960 EAST FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-5710
Practice Address - Country:US
Practice Address - Phone:713-453-3559
Practice Address - Fax:713-453-5861
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX165441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0076168-03Medicaid
TX0076168-04Medicaid
TX0076168-06Medicaid
TX0076168-05Medicaid
TX0076168-07Medicaid