Provider Demographics
NPI:1194989319
Name:THOMPSON, HOLLY ANN (DDS)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:ANN
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 1:131 CARMICHAEL RD
Mailing Address - Street 2:203
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-8269
Mailing Address - Country:US
Mailing Address - Phone:715-381-9710
Mailing Address - Fax:715-381-9728
Practice Address - Street 1:131 CARMICHAEL RD
Practice Address - Street 2:203
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-8269
Practice Address - Country:US
Practice Address - Phone:715-381-9710
Practice Address - Fax:715-381-9728
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6283-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice