Provider Demographics
NPI:1710103874
Name:THOMPSON, LARRY WAYNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:WAYNE
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 1:1360 S WADSWORTH BLVD
Mailing Address - Street 2:#300
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80232-5415
Mailing Address - Country:US
Mailing Address - Phone:303-986-9505
Mailing Address - Fax:303-986-2089
Practice Address - Street 1:1360 S WADSWORTH BLVD
Practice Address - Street 2:#300
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-5415
Practice Address - Country:US
Practice Address - Phone:303-986-9505
Practice Address - Fax:303-986-2089
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1043491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02043495Medicaid