MEDICARE: DR. FREDERICK H THOMPSON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DS3806	TN

General Provider Information

NPI Number	:	1447508098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FREDERICK H THOMPSON DDS

Provider Business Mailing Address
First Line	:	4109 MOUNTAIN VIEW AVE
Second Line	:	SUITE 300
City	:	CHATTANOOGA
State	:	TN
Zip	:	37415-2096
Country	:	US
Telephone Number	:	423-875-5661
Fax Number	:	423-875-5881

Provider Business Practice Location Address
First Line	:	4109 MOUNTAIN VIEW AVE
Second Line	:	SUITE 300
City	:	CHATTANOOGA
State	:	TN
Zip	:	37415-2096
Country	:	US
Telephone Number	:	423-875-5661
Fax Number	:	423-875-5881

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2012
Last Update Date	:	08/29/2012

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