Provider Demographics
NPI:1811071871
Name:THOMPSON, DAMON BENNETT (DDS)
Entity type:Individual
Prefix:DR
First Name:DAMON
Middle Name:BENNETT
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 1:250 SOUTH MAIN STREET, SUITE 212
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060
Mailing Address - Country:US
Mailing Address - Phone:540-552-5433
Mailing Address - Fax:540-552-2273
Practice Address - Street 1:250 SOUTH MAIN STREET, SUITE 212
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060
Practice Address - Country:US
Practice Address - Phone:540-552-5433
Practice Address - Fax:540-552-2273
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA041008616122300000X
VA401008616122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9178608Medicaid