Healthcare Provider Details

I. General information

NPI: 1831362367
Provider Name (Legal Business Name): WILLIAM B THOMPSON DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2008
Last Update Date: 04/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 CHILHOWIE STREET
CHILHOWIE VA
24319
US

IV. Provider business mailing address

PO BOX 318 409 CHILHOWIE STREET
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: WILLIAM BRODIE THOMPSON
Title or Position: OWNER DENTIST
Credential: DDS
Phone: 276-646-3541