Provider Demographics
NPI:1780772962
Name:THOMPSON, MICHAEL L (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2737 PAULA DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-8017
Mailing Address - Country:US
Mailing Address - Phone:870-932-0015
Mailing Address - Fax:870-932-0015
Practice Address - Street 1:2737 PAULA DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-8017
Practice Address - Country:US
Practice Address - Phone:870-932-0015
Practice Address - Fax:870-932-0015
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR28281223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics