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General NPI Number Information
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NPI Number | 1932883105
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Entity Type | Individual
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Provider Name | BRANDON KEITH THOMPSON DDS, MHS
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Gender | Male
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Dates
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Enumeration Date | 06/09/2023
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Last Update Date | 06/09/2023
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Provider Practice Location Address
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Address Line | 800 KIRTS BLVD STE 650
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City | TROY
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State | MI
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Zip | 48084-4850
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Country | US
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Telephone | 248-429-2229
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Fax |
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Provider Business Mailing Address
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Address Line | 6194 ANNE DR
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-3139
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Country | US
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Telephone | 248-661-6986
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Fax |
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 2901601504
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License Number State | MI
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