Individual
DR. MATTHEW THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
800 E 30TH ST BLDG 3, FARMINGTON, NM 87401-9407
(303) 724-6624
Mailing address
800 E 30TH ST BLDG 3, FARMINGTON, NM 87401-9407
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD5279
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134783723
—
NM
Enumeration date
04/29/2019
Last updated
12/02/2020
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