Provider Demographics
NPI:1881808657
Name:THOMPSON, SHAWN LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:LEE
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 1:3790 FERNANDINA RD STE 201
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-3864
Mailing Address - Country:US
Mailing Address - Phone:803-678-9999
Mailing Address - Fax:
Practice Address - Street 1:3790 FERNANDINA RD STE 201
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-3864
Practice Address - Country:US
Practice Address - Phone:803-678-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH206091223G0001X
SC10598122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice