Provider Demographics
NPI:1790076594
Name:THOMPSON, DARREN ALLEN (DDS)
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:ALLEN
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 1:2302 BUSH RIVER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-5649
Mailing Address - Country:US
Mailing Address - Phone:803-798-8675
Mailing Address - Fax:803-798-4753
Practice Address - Street 1:2302 BUSH RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-5649
Practice Address - Country:US
Practice Address - Phone:803-798-8675
Practice Address - Fax:803-798-4753
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC69881223G0001X
SC9141223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice