Provider Demographics
NPI:1750674495
Name:THOMPSON, JOHN ASHLEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ASHLEY
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 1:511 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:POWDERLY
Mailing Address - State:KY
Mailing Address - Zip Code:42367-5487
Mailing Address - Country:US
Mailing Address - Phone:270-338-5050
Mailing Address - Fax:270-338-5075
Practice Address - Street 1:511 W MAIN ST
Practice Address - Street 2:
Practice Address - City:POWDERLY
Practice Address - State:KY
Practice Address - Zip Code:42367-5487
Practice Address - Country:US
Practice Address - Phone:270-338-5050
Practice Address - Fax:270-338-5075
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY90061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9006Medicaid