Basic Information
| Provider Information | |||||||||
| NPI: | 1962467266 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | BRUCE | ||||||||
| MiddleName: | HOWARD | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 223 VILLA RAY DR | ||||||||
| Address2: | |||||||||
| City: | RADCLIFF | ||||||||
| State: | KY | ||||||||
| PostalCode: | 401609290 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2724 BRAVE RIFLES REGIMENT ROAD | ||||||||
| Address2: | HQS US ARMY DENTAL ACTIVITY | ||||||||
| City: | FORT KNOX | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026249670 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223E0200X | 6969 | KY | Y | Dental Providers | Dentist | Endodontics |
No ID Information.