MEDICARE: DR. CHARLES LADELL THOMPSON D.D.S.

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
1	1223G0001X	General Practice Dentistry	DS 2668	TN

General Provider Information

NPI Number	:	1568442499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES LADELL THOMPSON D.D.S.

Provider Business Mailing Address
First Line	:	4146 SUMMER AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38122-5228
Country	:	US
Telephone Number	:	901-458-0010
Fax Number	:

Provider Business Practice Location Address
First Line	:	4146 SUMMER AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38122-5228
Country	:	US
Telephone Number	:	901-458-0010
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. CHARLES LADELL THOMPSON D.D.S.” Practice Location

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