Basic Information
| Provider Information | |||||||||
| NPI: | 1770816985 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MELISSA M THOMPSON DMD, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3189 | ||||||||
| Address2: | |||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132203189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154546000 | ||||||||
| FaxNumber: | 3154545549 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 ELM ST | ||||||||
| Address2: | |||||||||
| City: | WOBURN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018011813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7819321114 | ||||||||
| FaxNumber: | 7813761593 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2009 | ||||||||
| LastUpdateDate: | 09/08/2009 | ||||||||
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| AuthorizedOfficialLastName: | BATTLE | ||||||||
| AuthorizedOfficialFirstName: | BAHIYA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROVIDER ENROLLMENT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3154546000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 21101 | MA | Y | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.