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General NPI Number Information
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NPI Number | 1629357454
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Entity Type | Individual
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Provider Name | SHIRLEY L THOMPSON RDHAP
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Gender | Female
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Dates
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Enumeration Date | 08/10/2011
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Last Update Date | 08/10/2011
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Provider Practice Location Address
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Address Line | 1111 24TH ST STE 204
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City | SACRAMENTO
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State | CA
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Zip | 95816-5019
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Country | US
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Telephone | 916-448-2161
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Fax | 916-448-2182
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Provider Business Mailing Address
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Address Line | 1111 24TH ST STE 204
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City | SACRAMENTO
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State | CA
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Zip | 95816-5019
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Country | US
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Telephone | 916-448-2161
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Fax | 916-448-2182
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | HAP12
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License Number State | CA
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