Provider Demographics
NPI:1811987282
Name:THOMPSON, AMY J (DMD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:J
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-2452
Mailing Address - Country:US
Mailing Address - Phone:607-432-4621
Mailing Address - Fax:
Practice Address - Street 1:53 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2452
Practice Address - Country:US
Practice Address - Phone:607-432-4621
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0445541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM9175837OtherGHI/FAMILY HEALTH PLUS
NM01396221Medicaid