Provider Demographics
NPI:1689800757
Name:THOMPSON, CHARMAINE L (MS, DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARMAINE
Middle Name:L
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MS, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3930 MCKINNEY AVE APT 261
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-2047
Mailing Address - Country:US
Mailing Address - Phone:919-423-1164
Mailing Address - Fax:
Practice Address - Street 1:1706 TREASURE HILLS BLVD
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8911
Practice Address - Country:US
Practice Address - Phone:956-365-6003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX250601223P0221X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223P0221XDental ProvidersDentistPediatric Dentistry