Provider Demographics
NPI:1184139081
Name:THOMPSON FAMILY DENTAL AT NORA
Entity type:Organization
Organization Name:THOMPSON FAMILY DENTAL AT NORA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JIYUN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-846-9444
Mailing Address - Street 1:1060 E 86TH ST STE 59
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1831
Mailing Address - Country:US
Mailing Address - Phone:317-846-9444
Mailing Address - Fax:
Practice Address - Street 1:1060 E 86TH ST STE 59
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1831
Practice Address - Country:US
Practice Address - Phone:317-846-9444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011822A261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental