=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679976161
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THOMPSON.FERGUSON.PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2014
-----------------------------------------------------
Last Update Date | 09/29/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10640 16TH AVE SW
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98146-2076
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-315-9936
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4309 W NOB HILL BLVD
-----------------------------------------------------
City | YAKIMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98908-3971
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-823-4480
-----------------------------------------------------
Fax | 509-823-4488
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FINANCE DIRECTOR
-----------------------------------------------------
Name | DAVID ANGOTTI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 509-823-4480
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DE60400620
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DE00010686
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DE60471711
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DE00009414
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DE60293839
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DE60232173
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #7
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DE60096080
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #8
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | DE00009045
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #9
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | DE60477207
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #10
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | DE60377112
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #11
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | DE60220488
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #12
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DE00009229
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------