Provider Demographics
NPI:1750507810
Name:LARRY THOMPSON, D.D.S., P.C
Entity Type:Organization
Organization Name:LARRY THOMPSON, D.D.S., P.C
Other - Org Name:LARRY W. THOMPSON, D.D.S., P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-986-9505
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1043491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02043495Medicaid