Provider Demographics
NPI:1154624229
Name:A L THOMPSON DMD PC & ASSOC.
Entity type:Organization
Organization Name:A L THOMPSON DMD PC & ASSOC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:L
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-747-3409
Mailing Address - Street 1:664 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BANKS
Mailing Address - State:OR
Mailing Address - Zip Code:97106-9042
Mailing Address - Country:US
Mailing Address - Phone:503-747-3409
Mailing Address - Fax:503-352-4147
Practice Address - Street 1:664 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BANKS
Practice Address - State:OR
Practice Address - Zip Code:97106-9042
Practice Address - Country:US
Practice Address - Phone:503-747-3409
Practice Address - Fax:503-352-4147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD76121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty