Individual
SAMANTHA THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
1630 FORTINO BLVD, PUEBLO, CO 81008-1856
(719) 545-2468
Mailing address
120 DOTSON AVE, PUEBLO, CO 81005-1215
(719) 251-5183
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
905515
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
80354068
—
CO
Enumeration date
01/28/2015
Last updated
01/28/2015
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