Healthcare Provider Details

I. General information

NPI: 1558446260
Provider Name (Legal Business Name): WILLIAM TODD THOMPSON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: W. TODD THOMPSON DMD

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 10/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CARSON RD SUITE 10
BATTLE MOUNTAIN NV
89820-2325
US

IV. Provider business mailing address

101 CARSON RD SUITE 10
BATTLE MOUNTAIN NV
89820-2325
US

V. Phone/Fax

Practice location:
  • Phone: 775-635-3300
  • Fax: 775-635-3322
Mailing address:
  • Phone: 775-635-3300
  • Fax: 775-635-3322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5083
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: