Provider Demographics
NPI:1982771945
Name:THOMPSON, ALBERT MATTHEW (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:MATTHEW
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:A
Other - Middle Name:MATTHEW
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:101 SNYDER HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850
Mailing Address - Country:US
Mailing Address - Phone:607-272-0901
Mailing Address - Fax:
Practice Address - Street 1:101 SNYDER HILL ROAD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850
Practice Address - Country:US
Practice Address - Phone:607-272-0901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040987122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY040987OtherLICENSE #