Healthcare Provider Details

I. General information

NPI: 1457667115
Provider Name (Legal Business Name): MICHAEL L. THOMPSON, MS, DDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2010
Last Update Date: 07/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2737 PAULA DR
JONESBORO AR
72404-8017
US

IV. Provider business mailing address

2737 PAULA DR
JONESBORO AR
72404-8017
US

V. Phone/Fax

Practice location:
  • Phone: 870-932-0015
  • Fax: 870-932-0015
Mailing address:
  • Phone: 870-932-0015
  • Fax: 870-932-0015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2828
License Number StateAR

VIII. Authorized Official

Name: DR. MICHAEL L. THOMPSON
Title or Position: OWNER
Credential: MS, DDS, PLLC
Phone: 870-932-0015