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General NPI Number Information
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NPI Number | 1750507810
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Entity Type | Organization
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Legal Business Name | LARRY THOMPSON, D.D.S., P.C
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1360 S WADSWORTH BLVD #300
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City | LAKEWOOD
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State | CO
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Zip | 80232-5415
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Country | US
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Telephone | 303-986-9505
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Fax | 303-986-2089
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Provider Business Mailing Address
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Address Line | 1360 S WADSWORTH BLVD #300
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City | LAKEWOOD
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State | CO
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Zip | 80232-5415
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Country | US
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Telephone | 303-986-9505
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Fax | 303-986-2089
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LARRY WAYNE THOMPSON
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Credential | D.D.S.
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Telephone | 303-986-9505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 104349
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License Number State | CO
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