Provider Demographics
NPI:1861508327
Name:THOMPSON, WENDELL C
Entity type:Individual
Prefix:DR
First Name:WENDELL
Middle Name:C
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 1:10025 W MARKHAM ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-1407
Mailing Address - Country:US
Mailing Address - Phone:501-224-1299
Mailing Address - Fax:501-224-9540
Practice Address - Street 1:10025 W MARKHAM ST
Practice Address - Street 2:SUITE 250
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-1407
Practice Address - Country:US
Practice Address - Phone:501-224-1299
Practice Address - Fax:501-224-9540
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR25601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice