Provider Demographics
NPI:1023154226
Name:THOMPSON, ELDON C JR (DDS)
Entity type:Individual
Prefix:DR
First Name:ELDON
Middle Name:C
Last Name:THOMPSON
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ELDON
Other - Middle Name:C
Other - Last Name:THOMPSON
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:208 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BERRYVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72616-3925
Mailing Address - Country:US
Mailing Address - Phone:870-423-2102
Mailing Address - Fax:870-423-5737
Practice Address - Street 1:208 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:AR
Practice Address - Zip Code:72616-3925
Practice Address - Country:US
Practice Address - Phone:870-423-2102
Practice Address - Fax:870-423-5737
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODEN 0135261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice