Healthcare Provider Details

I. General information

NPI: 1497804090
Provider Name (Legal Business Name): WESLEY B THOMPSON D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 E 400 S
EPHRAIM UT
84627-1336
US

IV. Provider business mailing address

561 E 100 N
EPHRAIM UT
84627-1210
US

V. Phone/Fax

Practice location:
  • Phone: 435-283-4081
  • Fax: 435-283-6151
Mailing address:
  • Phone: 435-283-0121
  • Fax: 435-283-6151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5684051-9922
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: