Healthcare Provider Details

I. General information

NPI: 1740744374
Provider Name (Legal Business Name): THOMPSON FERGUSON SCHRACK PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7604 NE 5TH AVE STE 114
VANCOUVER WA
98665-8200
US

IV. Provider business mailing address

4309 W NOB HILL BLVD
YAKIMA WA
98908-3971
US

V. Phone/Fax

Practice location:
  • Phone: 509-823-4480
  • Fax:
Mailing address:
  • Phone: 509-823-4480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DAVID ANGOTTI
Title or Position: FINANCIAL DIRECTOR
Credential:
Phone: 509-823-4480