1750507810 NPI number — LARRY THOMPSON, D.D.S., P.C

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750507810 NPI number — LARRY THOMPSON, D.D.S., P.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LARRY THOMPSON, D.D.S., P.C
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LARRY W. THOMPSON, D.D.S., P.C.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750507810
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1360 S WADSWORTH BLVD
Provider Second Line Business Mailing Address:
#300
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80232-5415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-986-9505
Provider Business Mailing Address Fax Number:
303-986-2089

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1360 S WADSWORTH BLVD
Provider Second Line Business Practice Location Address:
#300
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80232-5415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-986-9505
Provider Business Practice Location Address Fax Number:
303-986-2089
Provider Enumeration Date:
04/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
THOMPSON
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
WAYNE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
303-986-9505

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  104349 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02043495 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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