Provider Demographics
NPI:1205905007
Name:THOMPSON, THOMAS J (DMD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 COLEBROOK RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-9534
Mailing Address - Country:US
Mailing Address - Phone:717-274-3782
Mailing Address - Fax:717-272-1294
Practice Address - Street 1:1151 CORNWALL RD
Practice Address - Street 2:SUITE #1
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7233
Practice Address - Country:US
Practice Address - Phone:717-272-6953
Practice Address - Fax:717-272-1294
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024897L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice