Provider Demographics
NPI:1861918542
Name:THOMPSON, THERESA MARY (RDH,PHDHP)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:MARY
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RDH,PHDHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 BRANDYWINE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-3204
Mailing Address - Country:US
Mailing Address - Phone:215-235-9600
Mailing Address - Fax:
Practice Address - Street 1:DELAWARE VALLEY COMMUNITY HEALTH
Practice Address - Street 2:1412 FAIRMOUNT AVENUE
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130
Practice Address - Country:US
Practice Address - Phone:215-235-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist