Healthcare Provider Details

I. General information

NPI: 1801556436
Provider Name (Legal Business Name): ANITA THOMPSOON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2021
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1287 BRENTWOOD RD NE APT 8
WASHINGTON DC
20018-1032
US

IV. Provider business mailing address

1287 BRENTWOOD RD NE APT 8
WASHINGTON DC
20018-1032
US

V. Phone/Fax

Practice location:
  • Phone: 202-819-5723
  • Fax:
Mailing address:
  • Phone: 202-819-5723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License NumberDENA001380
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: