Healthcare Provider Details

I. General information

NPI: 1144420233
Provider Name (Legal Business Name): MATTHEW BRADFORD THOMPSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5745 ERINDALE DR STE 200
COLORADO SPRINGS CO
80918-8902
US

IV. Provider business mailing address

4167 NOTCH TRL
COLORADO SPRINGS CO
80924-4402
US

V. Phone/Fax

Practice location:
  • Phone: 719-599-7665
  • Fax:
Mailing address:
  • Phone: 719-377-1371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number202780
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0023429
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: