Provider Demographics
NPI:1649164898
Name:ISLAND DENTAL PARTNERS, LLC
Entity type:Organization
Organization Name:ISLAND DENTAL PARTNERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:912-638-9921
Mailing Address - Street 1:2487 DEMERE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ST SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-5640
Mailing Address - Country:US
Mailing Address - Phone:912-638-9921
Mailing Address - Fax:
Practice Address - Street 1:123 MAIN ST
Practice Address - Street 2:
Practice Address - City:ST SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-1680
Practice Address - Country:US
Practice Address - Phone:912-638-9921
Practice Address - Fax:912-638-4121
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. SIMONS ISLAND DENTAL ASSOCIATES, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty