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NPI Code Detail

MEDICARE: DR. AJA TRANISE THOMPSON

MEDICARE:  DR. AJA TRANISE THOMPSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry27014TX

General Provider Information

NPI Number : 1053698118
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AJA TRANISE THOMPSON
Provider Business Mailing Address
First Line : 4207 LIVE OAK ST
Second Line : #2303
City : DALLAS
State : TX
Zip : 75204-6705
Country : US
Telephone Number : 678-478-1091
Fax Number :
Provider Business Practice Location Address
First Line : 5422 RIVER OAKS BLVD
Second Line :
City : RIVER OAKS
State : TX
Zip : 76114-3349
Country : US
Telephone Number : 817-984-8585
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2011
Last Update Date : 11/03/2011

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Directions to “ DR. AJA TRANISE THOMPSON ” Practice Location

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