Basic Information
| Provider Information | |||||||||
| NPI: | 1710266416 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | SHANI | ||||||||
| MiddleName: | O | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 228 BEEMAN PL | ||||||||
| Address2: | US ARMY DENTAL ACTIVITY | ||||||||
| City: | FORT RILEY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 664427009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852397241 | ||||||||
| FaxNumber: | 7852405749 | ||||||||
| Practice Location | |||||||||
| Address1: | 8476 SIMMOND ST | ||||||||
| Address2: | |||||||||
| City: | FORT MEADE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207557083 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7862106562 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2011 | ||||||||
| LastUpdateDate: | 04/12/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 8059623-9921 | UT | Y | Dental Providers | Dentist | General Practice | 122300000X | 8059623-9921 | UT | N | Dental Providers | Dentist |
No ID Information.