Healthcare Provider Details

I. General information

NPI: 1659464063
Provider Name (Legal Business Name): JOSEPH THOMPSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 W 16TH ST BLDG 8-E
GREELEY CO
80634-6862
US

IV. Provider business mailing address

3400 W 16TH ST BLDG 8-E
GREELEY CO
80634-6862
US

V. Phone/Fax

Practice location:
  • Phone: 970-351-6500
  • Fax: 970-351-8788
Mailing address:
  • Phone: 970-351-6500
  • Fax: 970-351-8788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8821
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: