1134642945 NPI number — MRS. JULIE ANN THOMPSON RDH

Table of content: MRS. JULIE ANN THOMPSON RDH (NPI 1134642945)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134642945 NPI number — MRS. JULIE ANN THOMPSON RDH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
JULIE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RDH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THOMPSON
Provider Other First Name:
JULIE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
R.D.H
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1134642945
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
792 STILLWATER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BANGOR
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-947-1166
Provider Business Mailing Address Fax Number:
207-947-6123

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
792 STILLWATER AVE
Provider Second Line Business Practice Location Address:
MAINE FAMILY DENTAL
Provider Business Practice Location Address City Name:
BANGOR
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-947-1166
Provider Business Practice Location Address Fax Number:
207-947-6123
Provider Enumeration Date:
07/24/2017

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: 124Q00000X , with the licence number:  3010 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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