Healthcare Provider Details

I. General information

NPI: 1497675185
Provider Name (Legal Business Name): THOMPSON MAINSTAY II LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 SW MARLOW AVE STE 100
PORTLAND OR
97225-5177
US

IV. Provider business mailing address

1951 OAK ST STE A
FOREST GROVE OR
97116-2005
US

V. Phone/Fax

Practice location:
  • Phone: 503-297-1717
  • Fax:
Mailing address:
  • Phone: 503-357-9122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JARED M THOMPSON
Title or Position: OWNER
Credential: DMD
Phone: 503-351-9043