Provider Demographics
NPI:1699909903
Name:THOMPSON, SHAUN ANDERSON (DDS)
Entity type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:ANDERSON
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 ISLAND PL E
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-8981
Mailing Address - Country:US
Mailing Address - Phone:865-548-7448
Mailing Address - Fax:323-395-0452
Practice Address - Street 1:22 N JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-3334
Practice Address - Country:US
Practice Address - Phone:931-526-3381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPENDING122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist