Provider Demographics
NPI:1356567218
Name:THOMSON, DIANNE M (DDS PA)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:M
Last Name:THOMSON
Suffix:
Gender:F
Credentials:DDS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6009 BELT LINE ROAD
Mailing Address - Street 2:STE #120
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254
Mailing Address - Country:US
Mailing Address - Phone:972-233-9994
Mailing Address - Fax:972-233-4149
Practice Address - Street 1:6009 BELT LINE ROAD
Practice Address - Street 2:STE #120
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254
Practice Address - Country:US
Practice Address - Phone:972-233-9994
Practice Address - Fax:972-233-4149
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX150711223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics