Healthcare Provider Details

I. General information

NPI: 1588749675
Provider Name (Legal Business Name): ROBERT WAYNE THOMPSON DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DR. R WAYNE THOMPSON

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11005 W 60TH ST SUITE 180
SHAWNEE KS
66203-2913
US

IV. Provider business mailing address

10615 W 70TH TERR
SHAWNEE KS
66203
US

V. Phone/Fax

Practice location:
  • Phone: 913-631-0110
  • Fax: 913-631-5656
Mailing address:
  • Phone: 913-268-9856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number4563
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: