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NPI Code Detail

MEDICARE: DR. KELLEY THOMPSON DDS

MEDICARE: DR. KELLEY THOMPSON DDS
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
11223G0001XGeneral Practice Dentistry2794AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083628796
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KELLEY THOMPSON DDS
Provider Business Mailing Address
First Line : 6226 BASELINE RD
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72209-4728
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6226 BASELINE RD
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72209-4728
Country : US
Telephone Number : 501-562-4123
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2006
Last Update Date : 07/30/2020

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Directions to “ DR. KELLEY THOMPSON DDS” Practice Location

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