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General NPI Number Information
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NPI Number | 1972800969
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Entity Type | Organization
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Legal Business Name | ELDON C. THOMPSON, JR. DDS LLC
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Dates
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Enumeration Date | 02/28/2011
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Last Update Date | 02/28/2011
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Provider Practice Location Address
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Address Line | 208 N MAIN ST
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City | BERRYVILLE
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State | AR
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Zip | 72616-3925
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Country | US
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Telephone | 870-423-2102
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Fax | 870-423-5737
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Provider Business Mailing Address
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Address Line | 208 N MAIN ST
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City | BERRYVILLE
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State | AR
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Zip | 72616-3925
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Country | US
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Telephone | 870-423-2102
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Fax | 870-423-5737
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. ELDON C THOMPSON JR.
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Credential | DDS
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Telephone | 870-423-2102
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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 | 3747AR
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License Number State | AR
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