Provider Demographics
NPI:1598820243
Name:THOMPSON, MICHAEL R (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
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 1:7520 MONTGOMERY BLVD NE
Mailing Address - Street 2:SUITE D7
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1521
Mailing Address - Country:US
Mailing Address - Phone:505-884-7333
Mailing Address - Fax:
Practice Address - Street 1:7520 MONTGOMERY BLVD NE
Practice Address - Street 2:SUITE D7
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1521
Practice Address - Country:US
Practice Address - Phone:505-884-7333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMD14251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice