Provider Demographics
NPI:1962663336
Name:THOMPSON, MARLA JEAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARLA
Middle Name:JEAN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1191 WORTHINGTON DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1285
Mailing Address - Country:US
Mailing Address - Phone:412-442-7214
Mailing Address - Fax:412-443-7214
Practice Address - Street 1:1191 WORTHINGTON DR
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1285
Practice Address - Country:US
Practice Address - Phone:412-442-7214
Practice Address - Fax:412-443-7214
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3964122300000X
PADS037694122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist