Provider Demographics
NPI:1588749675
Name:THOMPSON, ROBERT WAYNE (DDS MS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WAYNE
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:DR
Other - First Name:R
Other - Middle Name:WAYNE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:10615 W 70TH TERR
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66203
Mailing Address - Country:US
Mailing Address - Phone:913-268-9856
Mailing Address - Fax:
Practice Address - Street 1:11005 W 60TH ST
Practice Address - Street 2:SUITE 180
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66203-2913
Practice Address - Country:US
Practice Address - Phone:913-631-0110
Practice Address - Fax:913-631-5656
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45631223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics