Active NPI
Kenneth Clyde Thompson, D.D.S.
- Pediatric Dentistry
- Mount Pleasant, TX
National Provider Identifier
1689697237
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 20214
- Practice address
- 203 W 20TH St
Suite B
Mount Pleasant, TX 75455-1100 - Phone
- (903) 577-9900
- Fax
- (903) 577-9901
- NPI assigned
- Jul 25, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 20214 | TX | Primary |
Addresses
Primary practice location
203 W 20TH St
Suite B
Mount Pleasant, TX 75455-1100
Mailing address
203 W 20TH St
Suite B
Mount Pleasant, TX 75455-1100
Phone (903) 577-9900
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 87D558 | Other | TX | TEXAS BCBS ID NUMBER |
| 20214 | Other | TX | LICENSE NUMBER |
| 90075488 | Other | TX | ALABAMA BCBS ID NUMBER |
| 1387039 | Other | TX | UNITED CONCORDIA ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20214 | TX | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1689697237",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "203 W 20TH ST",
"address_2": "SUITE B",
"city": "MOUNT PLEASANT",
"state": "TX",
"postal_code": "754551100",
"telephone_number": "903-577-9900",
"fax_number": "903-577-9901"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "203 W 20TH ST",
"address_2": "SUITE B",
"city": "MOUNT PLEASANT",
"state": "TX",
"postal_code": "754551100",
"telephone_number": "903-577-9900",
"fax_number": "903-577-9901"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THOMPSON",
"first_name": "KENNETH",
"middle_name": "CLYDE",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-25",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "TX",
"license": "20214",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TEXAS BCBS ID NUMBER",
"identifier": "87D558",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE NUMBER",
"identifier": "20214",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ALABAMA BCBS ID NUMBER",
"identifier": "90075488",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA ID",
"identifier": "1387039",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mount Pleasant, TX
- Thelma M Hernandez MD PA
- Therapy Learning Center, East Texas Clinic
- Thi of Texas at Mount Pleasant I LLC
- Thi of Texas at Mount Pleasant II, LLC
- Rebecca P Thomas, CRNA
- Richard Tris Thurman, PTA
- Stephanie Thurman, RPH
- Thurmans Pro-Med Pharmacy LLC
- Thurmans Pro-Med Pharmacy LLC (Long Term Care Div)
- Titus County Hospital District
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.