Provider Demographics
NPI:1093877359
Name:THOMPSON, WILLIAM ROY (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ROY
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 1:122 HERITAGE PARK DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-0563
Mailing Address - Country:US
Mailing Address - Phone:615-896-1330
Mailing Address - Fax:615-896-1358
Practice Address - Street 1:122 HERITAGE PARK DR
Practice Address - Street 2:SUITE 300
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-0563
Practice Address - Country:US
Practice Address - Phone:615-896-1330
Practice Address - Fax:615-896-1358
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3344122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3344OtherSTATE LICENSE
TN1404525OtherUNITED CONCORDIA ID
TN2006346OtherBCBS PROVIDER NUMBER
TN2006346OtherBCBS PROVIDER NUMBER