Provider Demographics
NPI:1962888552
Name:THOMPSON, BENJAMIN
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 WYATT DR
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-6810
Mailing Address - Country:US
Mailing Address - Phone:270-247-1966
Mailing Address - Fax:270-247-5471
Practice Address - Street 1:312 WYATT DR
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-6810
Practice Address - Country:US
Practice Address - Phone:270-247-1966
Practice Address - Fax:270-247-5471
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9602122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist