Healthcare Provider Details

I. General information

NPI: 1538513338
Provider Name (Legal Business Name): SEAN R. THOMPSON DDS PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 04/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25500 RANCHO NIGUEL RD STE 220
LAGUNA NIGUEL CA
92677-7373
US

IV. Provider business mailing address

25500 RANCHO NIGUEL RD STE 220
LAGUNA NIGUEL CA
92677-7373
US

V. Phone/Fax

Practice location:
  • Phone: 949-916-0178
  • Fax: 949-916-0238
Mailing address:
  • Phone: 949-916-0178
  • Fax: 949-916-0238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number47572
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number47572
License Number StateCA

VIII. Authorized Official

Name: DR. SEAN R. THOMPSON
Title or Position: DENTIST/OWNER
Credential: D.D.S.
Phone: 949-916-0178