Individual
DR. KENNETH CLYDE THOMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
203 W 20TH ST, SUITE B, MOUNT PLEASANT, TX 75455-1100
(903) 577-9900
(903) 577-9901
Mailing address
203 W 20TH ST, SUITE B, MOUNT PLEASANT, TX 75455-1100
(903) 577-9900
(903) 577-9901
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
20214
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1387039
UNITED CONCORDIA ID
TX
01
—
20214
LICENSE NUMBER
TX
01
—
87D558
TEXAS BCBS ID NUMBER
TX
01
—
90075488
ALABAMA BCBS ID NUMBER
TX
Enumeration date
07/25/2006
Last updated
03/07/2023
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