MEDICARE: ANDREW L THOMPSON DMD PC & ASSOC.

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	122300000X	Dentist	D7612	OR

General Provider Information

NPI Number	:	1487913083
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDREW L THOMPSON DMD PC & ASSOC.

Provider Business Mailing Address
First Line	:	4074 NW SALTZMAN RD STE 107
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97229-2423
Country	:	US
Telephone Number	:	503-629-8005
Fax Number	:	503-629-9775

Provider Business Practice Location Address
First Line	:	4074 NW SALTZMAN RD STE 107
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97229-2423
Country	:	US
Telephone Number	:	503-629-8005
Fax Number	:	503-629-9775

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANDREW LEE THOMPSON
Credential	:	DMD
Telephone Number	:	503-629-8005

Provider Enumeration Date	:	05/16/2012
Last Update Date	:	05/24/2012

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