Provider Demographics
NPI:1710009543
Name:THOMPSON, JOHN R JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:THOMPSON
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2517 WALNUT STREET
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17103-1753
Mailing Address - Country:US
Mailing Address - Phone:717-232-1951
Mailing Address - Fax:
Practice Address - Street 1:2517 WALNUT STREET
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17103-1753
Practice Address - Country:US
Practice Address - Phone:717-232-1951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018157L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAAT5830206OtherDEA