Provider Demographics
NPI:1194100016
Name:THOMPSON, KELSEY M (DDS)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:M
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2289 NORWALK ST
Mailing Address - Street 2:
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-3416
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 JOHNSON DR
Practice Address - Street 2:
Practice Address - City:MC GREGOR
Practice Address - State:TX
Practice Address - Zip Code:76657-1441
Practice Address - Country:US
Practice Address - Phone:254-313-5200
Practice Address - Fax:254-313-5299
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN101271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice