Provider Demographics
NPI:1659359651
Name:THOMPSON, CAROL D
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:D
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:CAROL
Other - Middle Name:D
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:12415 LANEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-2447
Mailing Address - Country:US
Mailing Address - Phone:281-320-1035
Mailing Address - Fax:281-444-0477
Practice Address - Street 1:3648 FM 1960 RD W
Practice Address - Street 2:SUITE 210
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77068-3617
Practice Address - Country:US
Practice Address - Phone:281-444-7977
Practice Address - Fax:281-444-7044
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX166041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111150201Medicaid