Provider Demographics
NPI:1609518141
Name:THOMPSON, ALISHA NICOLE (DMD, MPH)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:NICOLE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:ALISHA
Other - Middle Name:NICOLE
Other - Last Name:JIMENEZ-THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5500 BROADVIEW RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-1606
Mailing Address - Country:US
Mailing Address - Phone:216-351-5500
Mailing Address - Fax:
Practice Address - Street 1:5500 BROADVIEW RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-1606
Practice Address - Country:US
Practice Address - Phone:216-351-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0268331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice