Provider Demographics
NPI:1487913083
Name:ANDREW L THOMPSON DMD PC & ASSOC.
Entity type:Organization
Organization Name:ANDREW L THOMPSON DMD PC & ASSOC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-629-8005
Mailing Address - Street 1:4074 NW SALTZMAN RD STE 107
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-2423
Mailing Address - Country:US
Mailing Address - Phone:503-629-8005
Mailing Address - Fax:503-629-9775
Practice Address - Street 1:4074 NW SALTZMAN RD STE 107
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-2423
Practice Address - Country:US
Practice Address - Phone:503-629-8005
Practice Address - Fax:503-629-9775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD7612122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty