Provider Demographics
NPI:1427594076
Name:R SCOTT THOMPSON, DDS, PA
Entity type:Organization
Organization Name:R SCOTT THOMPSON, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:R
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:941-488-7910
Mailing Address - Street 1:1314 E VENICE AVE STE F
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-7160
Mailing Address - Country:US
Mailing Address - Phone:941-488-7910
Mailing Address - Fax:941-480-0839
Practice Address - Street 1:1314 E VENICE AVE STE F
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-7160
Practice Address - Country:US
Practice Address - Phone:941-488-7910
Practice Address - Fax:941-480-0839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN11717122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL511613837863OtherMEDICARE CCN