Healthcare Provider Details

I. General information

NPI: 1457310914
Provider Name (Legal Business Name): WILLIAM BRODIE THOMPSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 05/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 CHILHOWIE ST
CHILHOWIE VA
24319
US

IV. Provider business mailing address

PO BOX 318 409 CHILHOWIE ST
CHILHOWIE VA
24319
US

V. Phone/Fax

Practice location:
  • Phone: 276-646-3541
  • Fax: 276-646-4129
Mailing address:
  • Phone: 276-646-3541
  • Fax: 276-646-4129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401007458
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: