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General NPI Number Information
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NPI Number | 1538438478
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Entity Type | Organization
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Legal Business Name | THOMPSON TOM, D.D.S., A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 12/21/2011
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Last Update Date | 12/21/2011
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Provider Practice Location Address
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Address Line | 5990 STONERIDGE DR STE 115
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City | PLEASANTON
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State | CA
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Zip | 94588-3234
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Country | US
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Telephone | 925-734-0748
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Fax |
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Provider Business Mailing Address
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Address Line | 5990 STONERIDGE DR STE 115
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City | PLEASANTON
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State | CA
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Zip | 94588-3234
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Country | US
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Telephone | 925-734-0748
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | THOMPSON TOM
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Credential | D.D.S.
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Telephone | 925-734-0748
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 32623
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License Number State | CA
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