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NPI Code Detail

MEDICARE: DR. GARY M THOMPSON DMD

MEDICARE: DR. GARY M THOMPSON DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist4473KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14730OTHERKYDELTA DENTAL OF KENTUCKY
2Y945OTHERKYBLUE CROSS-BLUE SHIELD
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003897273
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GARY M THOMPSON DMD
Provider Business Mailing Address
First Line : 889 BOONE CREEK RD
Second Line :
City : STANTON
State : KY
Zip : 40380-9435
Country : US
Telephone Number : 606-663-2133
Fax Number : 606-663-0699
Provider Business Practice Location Address
First Line : 131 N MAIN ST
Second Line :
City : STANTON
State : KY
Zip : 40380-2174
Country : US
Telephone Number : 606-663-2133
Fax Number : 606-663-0699
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2005
Last Update Date : 04/03/2013

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