Provider Demographics
NPI:1609448356
Name:THOMPSON, CRE'ANDRIA JAMILLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRE'ANDRIA
Middle Name:JAMILLE
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 1:3365 REGENT BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3126
Mailing Address - Country:US
Mailing Address - Phone:469-351-6010
Mailing Address - Fax:
Practice Address - Street 1:3365 REGENT BLVD STE 120
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3126
Practice Address - Country:US
Practice Address - Phone:469-351-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX372281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice