Provider Demographics
NPI:1639106354
Name:THOMPSON, SUSAN S (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:S
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 1:7930 SKYLAND RIDGE PKWY STE 202
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-6815
Mailing Address - Country:US
Mailing Address - Phone:919-484-2617
Mailing Address - Fax:919-484-9031
Practice Address - Street 1:7930 SKYLAND RIDGE PKWY STE 202
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-6815
Practice Address - Country:US
Practice Address - Phone:919-484-2617
Practice Address - Fax:919-484-9031
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC78081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice