Provider Demographics
NPI:1316933518
Name:THOMPSON, KERRI RENEE' (DDS)
Entity type:Individual
Prefix:DR
First Name:KERRI
Middle Name:RENEE'
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 1:3019 S PARKWAY CT
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-7752
Mailing Address - Country:US
Mailing Address - Phone:620-343-8000
Mailing Address - Fax:620-343-9511
Practice Address - Street 1:2518 W 15TH AVE
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-6102
Practice Address - Country:US
Practice Address - Phone:620-343-8000
Practice Address - Fax:620-343-9511
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS603571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice