Provider Demographics
NPI:1598966467
Name:THOMPSON, BRIAN C (DMD)
Entity Type:Individual
Prefix:
First Name:BRIAN
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 1:645 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-4223
Mailing Address - Country:US
Mailing Address - Phone:276-783-8131
Mailing Address - Fax:276-783-1839
Practice Address - Street 1:645 PARK BLVD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-4223
Practice Address - Country:US
Practice Address - Phone:276-783-8131
Practice Address - Fax:276-783-1839
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014116701223S0112X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist