Provider Demographics
NPI:1669560082
Name:THOMPSON, SHELBY ADRIENNE (RDA OMSA)
Entity type:Individual
Prefix:MS
First Name:SHELBY
Middle Name:ADRIENNE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RDA OMSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 COFFEE RD
Mailing Address - Street 2:SUITE E14
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3191
Mailing Address - Country:US
Mailing Address - Phone:209-522-9963
Mailing Address - Fax:209-522-5184
Practice Address - Street 1:1316 COFFEE RD
Practice Address - Street 2:SUITE E14
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3191
Practice Address - Country:US
Practice Address - Phone:209-522-9963
Practice Address - Fax:209-522-5184
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDA50815126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant