Brady O Thompson, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

0401417963 Issued in VA

Practice address

6958 Nebraska Ave BLDG 1608
Fort Leonard Wood, MO 65473-1618

Phone

(537) 596-0364

NPI assigned

Jul 18, 2022

Last updated

Jul 18, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Coalville Dental Care LLC

  • General Practice Dentistry
  • Coalville, UT
  • NPI 1437095817
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1658102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658102400000",
    "number": "1063147767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6958 NEBRASKA AVE BLDG 1608",
            "city": "FORT LEONARD WOOD",
            "state": "MO",
            "postal_code": "654731618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6958 NEBRASKA AVE BLDG 1608",
            "city": "FORT LEONARD WOOD",
            "state": "MO",
            "postal_code": "654731618",
            "telephone_number": "537-596-0364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMPSON",
        "first_name": "BRADY",
        "middle_name": "O",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-18",
        "last_updated": "2022-07-18",
        "certification_date": "2022-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401417963",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VIRGINIA BOARD OF DENTISTRY",
            "identifier": "0401417963",
            "state": "VA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "leonard-wood.tricar.mil",
            "affiliation": "N",
            "address_1": "6958 Nebraska Ave Bldg 1608",
            "city": "Fort Leonard Wood",
            "state": "MO",
            "country_code": "US",
            "postal_code": "654731618",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Leslie Jann Teague, RPH
• Marcus Stephens Teng, DO
• Joseph Patrick Tesene, DDS
• The Janz Corporation (Janz Medical Supply)
• Jon-Marc Thibodeau, PA-C
• Pamela Tingle
• Christine Marie Titko, MPT
• Richard Tarleton Tobias, DDS
• Kristen Anne Tobin, MD
• Priscilla Antonette Tolbert

• Dentist in Fort Leonard Wood, MO
• Providers in Fort Leonard Wood, MO by specialty
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.