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General NPI Number Information
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NPI Number | 1457667115
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Entity Type | Organization
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Legal Business Name | MICHAEL L. THOMPSON, MS, DDS, PLLC
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Dates
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Enumeration Date | 08/19/2010
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Last Update Date | 07/29/2011
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Provider Practice Location Address
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Address Line | 2737 PAULA DR
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City | JONESBORO
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State | AR
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Zip | 72404-8017
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Country | US
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Telephone | 870-932-0015
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Fax | 870-932-0015
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Provider Business Mailing Address
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Address Line | 2737 PAULA DR
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City | JONESBORO
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State | AR
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Zip | 72404-8017
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Country | US
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Telephone | 870-932-0015
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Fax | 870-932-0015
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL L. THOMPSON
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Credential | MS, DDS, PLLC
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Telephone | 870-932-0015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 2828
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License Number State | AR
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