Provider Demographics
NPI:1457412397
Name:THOMPSON, J TERRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:TERRY
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:TERRENCE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:602 DOCK ST
Mailing Address - Street 2:STE 102
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-6530
Mailing Address - Country:US
Mailing Address - Phone:907-225-3031
Mailing Address - Fax:907-225-3130
Practice Address - Street 1:602 DOCK ST
Practice Address - Street 2:STE 102
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-6530
Practice Address - Country:US
Practice Address - Phone:907-225-3031
Practice Address - Fax:907-225-3130
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice