MEDICARE: DR. KAITLYN MARIE THOMPSON DMD

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
1	122300000X	Dentist	DGD 8792	SC

General Provider Information

NPI Number	:	1588118756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAITLYN MARIE THOMPSON DMD

Provider Business Mailing Address
First Line	:	1401 LIGHTHOUSE DR
Second Line	:	UNIT 4126
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-6894
Country	:	US
Telephone Number	:	941-840-8927
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 LIGHTHOUSE DR
Second Line	:	UNIT 4126
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-6894
Country	:	US
Telephone Number	:	941-840-8927
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2016
Last Update Date	:	08/05/2016

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