MEDICARE: DR. BRUCE HOWARD THOMPSON D.M.D.

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	1223E0200X	Endodontics	6969	KY

General Provider Information

NPI Number	:	1962467266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE HOWARD THOMPSON D.M.D.

Provider Business Mailing Address
First Line	:	223 VILLA RAY DR
Second Line	:
City	:	RADCLIFF
State	:	KY
Zip	:	40160-9290
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2724 BRAVE RIFLES REGIMENT ROAD
Second Line	:	HQS US ARMY DENTAL ACTIVITY
City	:	FORT KNOX
State	:	KY
Zip	:	40121
Country	:	US
Telephone Number	:	502-624-9670
Fax Number	:

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

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	07/08/2007

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