1285654830 NPI number — SHUNDA THOMPSON DDS

Table of content: SHUNDA THOMPSON DDS (NPI 1285654830)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285654830 NPI number — SHUNDA THOMPSON DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
SHUNDA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THOMPSON BANKS
Provider Other First Name:
SHUNDA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1285654830
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12022 VIA PALAZZO LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CYPRESS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77429-7434
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-775-2888
Provider Business Mailing Address Fax Number:
281-359-5516

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3648 CYPRESS CREEK PKWY STE 246
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77068-3617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-919-2983
Provider Business Practice Location Address Fax Number:
281-359-5516
Provider Enumeration Date:
07/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  23564 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 23564 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223X0400X , with the licence number: 23564 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223X0400X , with the licence number: DN012649 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 186495115 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 18649114 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 836857158C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".