Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 4871 | NC |
N | 122300000X | Dentist | DN009114 | GA |
N | 1223P0106X | Oral and Maxillofacial Pathology | 4871 | NC |
N | 1223P0106X | Oral and Maxillofacial Pathology | DN009114 | GA |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 4871 | NC |
N | 1223S0112X | Oral and Maxillofacial Surgeon | DN009114 | GA |
NPI | 1023088994 |
---|---|
Provider Name | Dr. Stevan Hayden Thompson |
First Address | Greenville, NC 27834-5925 |
Second Address | Greenville, NC 27834-5925 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 07/09/2012 |