Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 4473 | KY |
NPI | 1003897273 |
---|---|
Provider Name | Dr. Gary M Thompson |
First Address | Stanton, KY 40380-9435 |
Second Address | Stanton, KY 40380-2174 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2005 |
Last Update Date | 03/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4730 | DELTA DENTAL OF KENTUCKY (01) | KY |
60044732 | (05) | KY |
Y945 | BLUE CROSS-BLUE SHIELD (01) | KY |