Healthcare Provider Details

I. General information

NPI: 1205996287
Provider Name (Legal Business Name): CHARLES THOMPSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S WHITE OAK RD
WHITE OAK TX
75693-1423
US

IV. Provider business mailing address

601 S WHITE OAK RD
WHITE OAK TX
75693-1423
US

V. Phone/Fax

Practice location:
  • Phone: 903-297-0712
  • Fax:
Mailing address:
  • Phone: 903-297-0712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number17119
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: