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General NPI Number Information
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NPI Number | 1376855445
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Entity Type | Individual
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Provider Name | BRANDI NICOLE THOMPSON DDS
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Gender | Female
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Dates
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Enumeration Date | 07/06/2010
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Last Update Date | 02/24/2011
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Provider Practice Location Address
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Address Line | 119 W MAIN ST
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City | HOMINY
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State | OK
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Zip | 74035-1031
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Country | US
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Telephone | 918-885-4640
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Fax | 918-885-4644
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Provider Business Mailing Address
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Address Line | 212 N MAIN ST
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City | FAIRFAX
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State | OK
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Zip | 74637-3023
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Country | US
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Telephone | 918-642-3100
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Fax | 918-642-5639
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6214
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License Number State | OK
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