Provider Demographics
NPI:1922249200
Name:LISA V. THOMPSON, DDS, LLC
Entity Type:Organization
Organization Name:LISA V. THOMPSON, DDS, LLC
Other - Org Name:LVT DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:VALDENE
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:240-455-7484
Mailing Address - Street 1:1450 MERCANTILE LN
Mailing Address - Street 2:SUITE 207A
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5376
Mailing Address - Country:US
Mailing Address - Phone:204-455-7484
Mailing Address - Fax:240-455-7476
Practice Address - Street 1:1450 MERCANTILE LN
Practice Address - Street 2:SUITE 207A
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5376
Practice Address - Country:US
Practice Address - Phone:204-455-7484
Practice Address - Fax:240-455-7476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13668261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental