Provider Demographics
NPI:1356599757
Name:THOMPSON, CONNOR L (DMD)
Entity type:Individual
Prefix:DR
First Name:CONNOR
Middle Name:L
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 1:35 E 400 S
Mailing Address - Street 2:
Mailing Address - City:EPHRAIM
Mailing Address - State:UT
Mailing Address - Zip Code:84627-1336
Mailing Address - Country:US
Mailing Address - Phone:435-283-4081
Mailing Address - Fax:435-283-6151
Practice Address - Street 1:35 E 400 S
Practice Address - Street 2:
Practice Address - City:EPHRAIM
Practice Address - State:UT
Practice Address - Zip Code:84627-1336
Practice Address - Country:US
Practice Address - Phone:435-283-4081
Practice Address - Fax:435-283-6151
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT700633699221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice