Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 0023429 | TX |
Y | 1223E0200X | Endodontist | 202780 | CO |
NPI | 1144420233 |
---|---|
Provider Name | Dr. Matthew Bradford Thompson |
First Address | Colorado Springs, CO 80924-4402 |
Second Address | Colorado Springs, CO 80918-8902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2007 |
Last Update Date | 02/05/2019 |