Provider Demographics
NPI:1477656452
Name:THOMPSON, LELAND R (DDS)
Entity Type:Individual
Prefix:DR
First Name:LELAND
Middle Name:R
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 1:35 E 400 S
Mailing Address - Street 2:P.O. BOX 816
Mailing Address - City:EPHRAIM
Mailing Address - State:UT
Mailing Address - Zip Code:84627
Mailing Address - Country:US
Mailing Address - Phone:435-283-4081
Mailing Address - Fax:435-283-6151
Practice Address - Street 1:35 E 400 S
Practice Address - Street 2:
Practice Address - City:EPHRAIM
Practice Address - State:UT
Practice Address - Zip Code:84627
Practice Address - Country:US
Practice Address - Phone:435-283-4081
Practice Address - Fax:435-283-6151
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT137852-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice