Provider Demographics
NPI:1558446260
Name:THOMPSON, WILLIAM TODD (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:TODD
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:W.
Other - Middle Name:TODD
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:101 CARSON RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:BATTLE MOUNTAIN
Mailing Address - State:NV
Mailing Address - Zip Code:89820-2325
Mailing Address - Country:US
Mailing Address - Phone:775-635-3300
Mailing Address - Fax:775-635-3322
Practice Address - Street 1:101 CARSON RD
Practice Address - Street 2:SUITE 10
Practice Address - City:BATTLE MOUNTAIN
Practice Address - State:NV
Practice Address - Zip Code:89820-2325
Practice Address - Country:US
Practice Address - Phone:775-635-3300
Practice Address - Fax:775-635-3322
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5083122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100513968Medicaid