Healthcare Provider Details

I. General information

NPI: 1144388075
Provider Name (Legal Business Name): RANDALL A THOMPSON DDS PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 REKDAL RD
CARMANO ISLAND WA
98282
US

IV. Provider business mailing address

810 REKDAL RD
CARMANO ISLAND WA
98282
US

V. Phone/Fax

Practice location:
  • Phone: 360-629-4097
  • Fax: 360-629-3906
Mailing address:
  • Phone: 360-629-4097
  • Fax: 360-629-3906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE00004408
License Number StateWA

VIII. Authorized Official

Name: DR. RANDELL ARTHUR THOMPSON
Title or Position: PRESIDENT CHAIRMAN OF THE BOARD
Credential: DDS
Phone: 360-629-4097