Provider Demographics
NPI:1518936194
Name:THOMPSON, DAVID C (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
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 1:3164 ALVEY PARK DR E
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-2132
Mailing Address - Country:US
Mailing Address - Phone:270-683-0620
Mailing Address - Fax:
Practice Address - Street 1:3164 ALVEY PARK DR E
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-2132
Practice Address - Country:US
Practice Address - Phone:270-683-0620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY58861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice