Provider Demographics
NPI:1912087859
Name:THOMPSON, AMANDA L (DMD)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:L
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 1:1932 LAUREL RD STE 1A
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1939
Mailing Address - Country:US
Mailing Address - Phone:205-823-6776
Mailing Address - Fax:205-823-6076
Practice Address - Street 1:1932 LAUREL ROAD STE. 1A
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216
Practice Address - Country:US
Practice Address - Phone:205-823-6776
Practice Address - Fax:205-823-6076
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4942122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist