Healthcare Provider Details

I. General information

NPI: 1992784482
Provider Name (Legal Business Name): STUART PATRICK THOMPSON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 SCOTT CIR
HICKAM AFB HI
96853-5399
US

IV. Provider business mailing address

525 FARRINGTON HWY STE 104
KAPOLEI HI
96707-2051
US

V. Phone/Fax

Practice location:
  • Phone: 808-448-6726
  • Fax:
Mailing address:
  • Phone: 808-674-8808
  • Fax: 808-674-8870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDT-2281
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: