Provider Demographics
NPI:1740562719
Name:ADAM THOMPSON DMD PLLC
Entity Type:Organization
Organization Name:ADAM THOMPSON DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-868-5999
Mailing Address - Street 1:203 CHAMPION WAY
Mailing Address - Street 2:SUITE #6
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-8861
Mailing Address - Country:US
Mailing Address - Phone:502-868-5999
Mailing Address - Fax:502-868-5944
Practice Address - Street 1:203 CHAMPION WAY
Practice Address - Street 2:SUITE #6
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-8861
Practice Address - Country:US
Practice Address - Phone:502-868-5999
Practice Address - Fax:502-868-5944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY81321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty