Provider Demographics
NPI:1740353663
Name:THOMPSON, THAD MARSH (DDS)
Entity type:Individual
Prefix:DR
First Name:THAD
Middle Name:MARSH
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:PO BOX 660
Mailing Address - Street 2:300 S. MAIN
Mailing Address - City:ODEBOLT
Mailing Address - State:IA
Mailing Address - Zip Code:51458-0660
Mailing Address - Country:US
Mailing Address - Phone:712-668-2219
Mailing Address - Fax:
Practice Address - Street 1:300 S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:ODEBOLT
Practice Address - State:IA
Practice Address - Zip Code:51458-0660
Practice Address - Country:US
Practice Address - Phone:712-668-2219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA067951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice