Individual
JONATHAN DERELL THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2030 HEIGHTS DR STE 2, HARKER HEIGHTS, TX 76548-2185
(254) 870-3221
Mailing address
6780 FORTINO ST APT 206, APPLE VALLEY, MN 55124-6609
(512) 848-5908
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
42176
TX
122300000X
Dentist
Primary
D14966
MN
390200000X
Student in an Organized Health Care Education/Training Program
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—
Other
Enumeration date
03/06/2023
Last updated
03/23/2026
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