Provider Demographics
NPI:1578570347
Name:THOMPSON, WILLIAM LEON (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LEON
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 1:703 N DUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-6101
Mailing Address - Country:US
Mailing Address - Phone:505-564-2350
Mailing Address - Fax:505-325-5002
Practice Address - Street 1:703 N DUSTIN AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-6101
Practice Address - Country:US
Practice Address - Phone:505-564-2350
Practice Address - Fax:505-325-5002
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD12601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice