1124757695 NPI number — KALEB C THOMPSON, DMD, PA II

Table of content: MRS. RACHEL RAGINA TAYLOR FNP (NPI 1942975206)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124757695 NPI number — KALEB C THOMPSON, DMD, PA II

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KALEB C THOMPSON, DMD, PA II
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124757695
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112 CURRITUCK COMMERICAL DR STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOYOCK
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27958-8746
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-335-4341
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 CURRITUCK COMMERICAL DR STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOYOCK
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27958-8746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-335-4341
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/08/2022

Additional Information

Authorized Official

Authorized Official Last Name:
HASLAM
Authorized Official First Name:
MONIQUE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
252-232-0800

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1710437322 . This is a "GENERAL DENTIST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com