MEDICARE: DR. PATRICK DES 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
1	1223G0001X	General Practice Dentistry	6490	NV

General Provider Information

NPI Number	:	1902169469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK DES THOMPSON DMD

Provider Business Mailing Address
First Line	:	2917 GILMARY AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2079
Country	:	US
Telephone Number	:	702-241-2018
Fax Number	:

Provider Business Practice Location Address
First Line	:	3450 S HUALAPAI WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-7707
Country	:	US
Telephone Number	:	702-871-6044
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2012
Last Update Date	:	07/12/2014

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