Provider Demographics
NPI:1316209216
Name:THOMPSON, ADAM D (DDS)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:D
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 S 18TH ST
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-3654
Mailing Address - Country:US
Mailing Address - Phone:509-573-5530
Mailing Address - Fax:509-654-7012
Practice Address - Street 1:1120 S 18TH ST
Practice Address - Street 2:YV TECH
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98948-0190
Practice Address - Country:US
Practice Address - Phone:509-573-5530
Practice Address - Fax:509-654-7012
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4245122300000X
WADE60467462122300000X
ORD10557122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist