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NPI Code Detail

MEDICARE: MICHAEL BENHAM THOMPSON

MEDICARE: MICHAEL BENHAM THOMPSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
21223P0221XPediatric Dentistry9508SC

General Provider Information

NPI Number : 1154824324
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL BENHAM THOMPSON
Provider Business Mailing Address
First Line : 205 CAROLINA AVE
Second Line :
City : GREENVILLE
State : SC
Zip : 29607-3213
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1376 CLEVELAND ST
Second Line :
City : GREENVILLE
State : SC
Zip : 29607-2435
Country : US
Telephone Number : 864-250-1100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2018
Last Update Date : 11/07/2024

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Directions to “ MICHAEL BENHAM THOMPSON ” Practice Location

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