Healthcare Provider Details

I. General information

NPI: 1841271020
Provider Name (Legal Business Name): THOMAS LEE THOMPSON D.D.S.,M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 05/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9713 OVERSEAS HWY
MARATHON FL
33050-3342
US

IV. Provider business mailing address

9713 OVERSEAS HWY
MARATHON FL
33050-3342
US

V. Phone/Fax

Practice location:
  • Phone: 305-395-2279
  • Fax:
Mailing address:
  • Phone: 305-395-2279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN14793
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: