Basic Information
| Provider Information | |||||||||
| NPI: | 1689800757 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | CHARMAINE | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MS, DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3930 MCKINNEY AVE APT 261 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752042047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194231164 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1706 TREASURE HILLS BLVD | ||||||||
| Address2: | |||||||||
| City: | HARLINGEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785508911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563656003 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2009 | ||||||||
| LastUpdateDate: | 03/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0221X | 25060 | TX | Y | Dental Providers | Dentist | Pediatric Dentistry |
No ID Information.