Healthcare Provider Details

I. General information

NPI: 1891081337
Provider Name (Legal Business Name): JENNIFER A THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 06/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 W 7TH ST SUITE 309
CINCINNATI OH
45203-1513
US

IV. Provider business mailing address

635 W 7TH ST SUITE 309
CINCINNATI OH
45203-1513
US

V. Phone/Fax

Practice location:
  • Phone: 513-621-0248
  • Fax: 513-621-0288
Mailing address:
  • Phone: 513-621-0248
  • Fax: 513-621-0288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number31010253
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: