Provider Demographics
NPI:1801978275
Name:THOMPSON, SHELBY E (DMD)
Entity type:Individual
Prefix:DR
First Name:SHELBY
Middle Name:E
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:SHELBY
Other - Middle Name:E
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:4426 HILLCREST OAKS
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1966
Mailing Address - Country:US
Mailing Address - Phone:270-685-5787
Mailing Address - Fax:
Practice Address - Street 1:2816 VEACH RD STE 301A
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-6297
Practice Address - Country:US
Practice Address - Phone:270-684-5395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY47751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60047750Medicaid
KY840912OtherUNITED CONCORDIA UNPROVID