Provider Demographics
NPI:1124325956
Name:AMY MOSLANDER-THOMPSON, DDS, PLLC
Entity type:Organization
Organization Name:AMY MOSLANDER-THOMPSON, DDS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:H
Authorized Official - Last Name:MOSLANDER-THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-397-8888
Mailing Address - Street 1:9633 MARKET PL
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-7944
Mailing Address - Country:US
Mailing Address - Phone:425-397-8888
Mailing Address - Fax:
Practice Address - Street 1:9633 MARKET PL
Practice Address - Street 2:SUITE 202
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-7944
Practice Address - Country:US
Practice Address - Phone:425-397-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00100001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty