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General NPI Number Information
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NPI Number | 1962616755
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Entity Type | Organization
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Legal Business Name | JASON THOMPSON, DDS,SC
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | S76W17527 JANESVILLE RD
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City | MUSKEGO
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State | WI
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Zip | 53150-9298
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Country | US
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Telephone | 262-679-2213
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Fax |
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Provider Business Mailing Address
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Address Line | S76W17527 JANESVILLE RD PO BOX 1
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City | MUSKEGO
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State | WI
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Zip | 53150-9298
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Country | US
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Telephone | 262-679-2213
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JASON THOMPSON
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Credential | DDS
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Telephone | 262-679-2213
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5453015
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License Number State | WI
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