Provider Demographics
NPI:1427506641
Name:THOMPSON, QUINCY LAWRENCE (DMD)
Entity type:Individual
Prefix:
First Name:QUINCY
Middle Name:LAWRENCE
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CHATWICK CV
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-5642
Mailing Address - Country:US
Mailing Address - Phone:253-861-1173
Mailing Address - Fax:
Practice Address - Street 1:113 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237-3344
Practice Address - Country:US
Practice Address - Phone:731-587-4742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-16
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10347122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist