Healthcare Provider Details

I. General information

NPI: 1598966467
Provider Name (Legal Business Name): BRIAN C THOMPSON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 07/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 PARK BLVD
MARION VA
24354-4223
US

IV. Provider business mailing address

645 PARK BLVD
MARION VA
24354-4223
US

V. Phone/Fax

Practice location:
  • Phone: 276-783-8131
  • Fax: 276-783-1839
Mailing address:
  • Phone: 276-783-8131
  • Fax: 276-783-1839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0401411670
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0401411670
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: