Individual
RICKEY SHANE THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
US HWY 491 NORTH, SHIPROCK, NM 67420
(505) 368-6401
(505) 368-6431
Mailing address
PO BOX 160, SHIPROCK, NM 87420-0160
(505) 368-6401
(505) 368-6431
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
15951
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02159515
—
CO
05
—
31847820
—
NM
05
—
689896
—
AZ
Enumeration date
10/14/2005
Last updated
09/20/2007
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