Provider Demographics
NPI:1710437322
Name:THOMPSON, KALEB (DMD)
Entity Type:Individual
Prefix:
First Name:KALEB
Middle Name:
Last Name:THOMPSON
Suffix:
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 1:125 TULIP TREE DR
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27921-8330
Mailing Address - Country:US
Mailing Address - Phone:801-636-6571
Mailing Address - Fax:
Practice Address - Street 1:408 E COLONIAL AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-4363
Practice Address - Country:US
Practice Address - Phone:252-335-4341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10455122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist