Provider Demographics
NPI:1639284847
Name:THOMPSON, REBECCA R (DDS)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:R
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:PO BOX 466
Mailing Address - Street 2:
Mailing Address - City:WASECA
Mailing Address - State:MN
Mailing Address - Zip Code:56093-0466
Mailing Address - Country:US
Mailing Address - Phone:507-835-1080
Mailing Address - Fax:507-835-1184
Practice Address - Street 1:1504 4TH ST. NE
Practice Address - Street 2:
Practice Address - City:WASECA
Practice Address - State:MN
Practice Address - Zip Code:56093
Practice Address - Country:US
Practice Address - Phone:507-835-1080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN114191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice