Provider Demographics
NPI:1972617769
Name:THOMPSON, JEREMY MARTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:MARTIN
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13003 VISTA HAVEN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216
Mailing Address - Country:US
Mailing Address - Phone:614-893-0256
Mailing Address - Fax:
Practice Address - Street 1:601 NW LOOP 410 STE 455
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216
Practice Address - Country:US
Practice Address - Phone:210-342-2444
Practice Address - Fax:210-342-2443
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS604171223E0200X, 122300000X
TX298571223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist