Provider Demographics
NPI:1043247034
Name:THOMPSON, PARKER LEIGH (DDS)
Entity type:Individual
Prefix:
First Name:PARKER
Middle Name:LEIGH
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 GARDEN GATE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504
Mailing Address - Country:US
Mailing Address - Phone:850-477-7574
Mailing Address - Fax:850-477-7794
Practice Address - Street 1:911 GARDEN GATE CIRCLE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504
Practice Address - Country:US
Practice Address - Phone:850-477-7574
Practice Address - Fax:850-477-7794
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12563122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
869834OtherUNITED CONCORDIA INS CO
FL63970OtherBLUE CROSS BLUE SHIELD
AL59095445OtherBLUE CROSS BLUE SHIELD