Individual
DR. BRADY O THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6958 NEBRASKA AVE BLDG 1608, FORT LEONARD WOOD, MO 65473-1618
(537) 596-0364
Mailing address
6958 NEBRASKA AVE BLDG 1608, FORT LEONARD WOOD, MO 65473-1618
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401417963
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0401417963
VIRGINIA BOARD OF DENTISTRY
VA
Enumeration date
07/18/2022
Last updated
07/18/2022
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