MEDICARE: THOMPSON AND AUDETTE DENTAL GROUP, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	57402	CA
2	1223G0001X	General Practice Dentistry	57353	CA

General Provider Information

NPI Number	:	1083022081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMPSON AND AUDETTE DENTAL GROUP, INC.

Provider Business Mailing Address
First Line	:	1001 PLAZA ESCALANTE
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91910-8135
Country	:	US
Telephone Number	:	310-756-2321
Fax Number	:

Provider Business Practice Location Address
First Line	:	1761 PALM AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92154-1150
Country	:	US
Telephone Number	:	619-429-5151
Fax Number	:	619-429-5834

Authorized Official
Title or Position	:	TREASURER
Name	:	DR. UYEN THOMPSON
Credential	:	D.D.S.
Telephone Number	:	310-756-2321

Provider Enumeration Date	:	07/23/2014
Last Update Date	:	07/23/2014

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Directions to “THOMPSON AND AUDETTE DENTAL GROUP, INC. ” Practice Location

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