Healthcare Provider Details

I. General information

NPI: 1336433937
Provider Name (Legal Business Name): WADE D THOMPSON DDS MS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 06/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 W CENTER ST
OREM UT
84057-4659
US

IV. Provider business mailing address

380 W CENTER ST
OREM UT
84057-4659
US

V. Phone/Fax

Practice location:
  • Phone: 801-375-7088
  • Fax: 801-375-4777
Mailing address:
  • Phone: 801-375-7088
  • Fax: 801-375-4777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number5823982-9921
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. WADE DAINES THOMPSON
Title or Position: PRESIDENT
Credential: DDS MS
Phone: 801-375-7088