Healthcare Provider Details

I. General information

NPI: 1700885027
Provider Name (Legal Business Name): WARREN H. THOMPSON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 LOVELL ST
IONIA MI
48846-9706
US

IV. Provider business mailing address

340 LOVELL ST P.O. BOX 118
IONIA MI
48846-9706
US

V. Phone/Fax

Practice location:
  • Phone: 616-527-3050
  • Fax: 616-527-3667
Mailing address:
  • Phone: 616-527-3050
  • Fax: 616-527-3667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10745
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: