Provider Demographics
NPI:1639500770
Name:SHELLEY A THOMPSON DDS LLC
Entity Type:Organization
Organization Name:SHELLEY A THOMPSON DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-203-5012
Mailing Address - Street 1:6025 S SUNBURY RD
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-3846
Mailing Address - Country:US
Mailing Address - Phone:614-891-6767
Mailing Address - Fax:614-895-4720
Practice Address - Street 1:6025 S SUNBURY RD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-3846
Practice Address - Country:US
Practice Address - Phone:614-891-6767
Practice Address - Fax:614-895-4720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHBT7414256122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHBT7414256OtherDEA LICENSE #