Provider Demographics
NPI:1902804016
Name:THOMSON, PATRICK BOYD (DMD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:BOYD
Last Name:THOMSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3
Mailing Address - Street 2:
Mailing Address - City:DIVIDE
Mailing Address - State:CO
Mailing Address - Zip Code:80814-0003
Mailing Address - Country:US
Mailing Address - Phone:719-687-1158
Mailing Address - Fax:
Practice Address - Street 1:207 N. WEST ST.
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80866
Practice Address - Country:US
Practice Address - Phone:719-687-6225
Practice Address - Fax:719-687-5633
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1046231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice