MEDICARE: WILLIAM B THOMPSON DDS PS

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	261QD0000X	Dental Clinic/Center	5335	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1639248446	OTHER	WA	TYPE 1 NPI NUMBER

General Provider Information

NPI Number	:	1902191331
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM B THOMPSON DDS PS

Provider Business Mailing Address
First Line	:	6840 FORT DENT WAY
Second Line	:	SUITE 130
City	:	TUKWILA
State	:	WA
Zip	:	98188-8513
Country	:	US
Telephone Number	:	206-242-5800
Fax Number	:	206-242-4166

Provider Business Practice Location Address
First Line	:	6840 FORT DENT WAY
Second Line	:	SUITE 130
City	:	TUKWILA
State	:	WA
Zip	:	98188-8513
Country	:	US
Telephone Number	:	206-242-5800
Fax Number	:	206-242-4166

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WILLIAM THOMPSON
Credential	:	DDS
Telephone Number	:	206-242-5800

Provider Enumeration Date	:	06/14/2011
Last Update Date	:	06/14/2011

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