Provider Demographics
NPI:1619065604
Name:THOMPSON, JOHN THEODORE (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:THEODORE
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 1:4101 US HWY 77 STE M 1A
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410
Mailing Address - Country:US
Mailing Address - Phone:361-242-3151
Mailing Address - Fax:361-242-8811
Practice Address - Street 1:4101 US HWY 77 STE M 1A
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410
Practice Address - Country:US
Practice Address - Phone:361-242-3151
Practice Address - Fax:361-242-8811
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX147041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice