Provider Demographics
NPI:1770320384
Name:THOMPSON, HALEY LAUREN (DMD)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:LAUREN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1851 STEAMBOAT PKWY UNIT 2902
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-6341
Mailing Address - Country:US
Mailing Address - Phone:813-416-4062
Mailing Address - Fax:
Practice Address - Street 1:1121 STEAMBOAT PKWY STE 700
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-6429
Practice Address - Country:US
Practice Address - Phone:775-418-7990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN29021122300000X
NV80621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist