Healthcare Provider Details

I. General information

NPI: 1285654830
Provider Name (Legal Business Name): SHUNDA THOMPSON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHUNDA THOMPSON BANKS DDS

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 VINTAGE PARK BLVD STE A
HOUSTON TX
77070-3998
US

IV. Provider business mailing address

12022 VIA PALAZZO LN
CYPRESS TX
77429-7434
US

V. Phone/Fax

Practice location:
  • Phone: 832-271-3200
  • Fax:
Mailing address:
  • Phone: 713-775-2888
  • Fax: 281-359-5516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number23564
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number23564
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number23564
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN012649
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: