Basic Information
| Provider Information | |||||||||
| NPI: | 1790076594 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | DARREN | ||||||||
| MiddleName: | ALLEN | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 S CHURCH ST | ||||||||
| Address2: | UNIT 2 | ||||||||
| City: | SPARTANBURG | ||||||||
| State: | SC | ||||||||
| PostalCode: | 293063306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8643984185 | ||||||||
| FaxNumber: | 8645737701 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 S CHURCH ST | ||||||||
| Address2: | UNIT 2 | ||||||||
| City: | SPARTANBURG | ||||||||
| State: | SC | ||||||||
| PostalCode: | 293063306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8643984185 | ||||||||
| FaxNumber: | 8645737701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2011 | ||||||||
| LastUpdateDate: | 04/27/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 6988 | SC | Y | Dental Providers | Dentist | General Practice |
No ID Information.