Provider Demographics
NPI:1487662466
Name:THOMPSON, GLENN DAVID (DMD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:DAVID
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 N MURRAY BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80915
Mailing Address - Country:US
Mailing Address - Phone:719-574-2211
Mailing Address - Fax:719-380-8563
Practice Address - Street 1:1711 N MURRAY BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80915
Practice Address - Country:US
Practice Address - Phone:719-574-2211
Practice Address - Fax:719-380-8563
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO84471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice