Provider Demographics
NPI:1134642945
Name:THOMPSON, JULIE ANN (RDH)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MRS
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDH
Mailing Address - Street 1:792 STILLWATER AVE
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401
Mailing Address - Country:US
Mailing Address - Phone:207-947-1166
Mailing Address - Fax:207-947-6123
Practice Address - Street 1:792 STILLWATER AVE
Practice Address - Street 2:MAINE FAMILY DENTAL
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-947-1166
Practice Address - Fax:207-947-6123
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3010124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist