Healthcare Provider Details

I. General information

NPI: 1376764233
Provider Name (Legal Business Name): DEREK THOMPSON DMD PATRICK FERGUSON DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 S 14TH ST
UNION GAP WA
98903-1252
US

IV. Provider business mailing address

2100 S 14TH ST
UNION GAP WA
98903-1252
US

V. Phone/Fax

Practice location:
  • Phone: 509-457-6300
  • Fax:
Mailing address:
  • Phone: 509-457-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE00009229
License Number StateWA

VIII. Authorized Official

Name: CATHY L MEADOWS
Title or Position: FINANCE MANAGER
Credential:
Phone: 509-457-6300