MEDICARE: RONALD WAYNE 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	21412	CA

General Provider Information

NPI Number	:	1558542233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD WAYNE THOMPSON DDS

Provider Business Mailing Address
First Line	:	6968 WARNER AVE
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-5316
Country	:	US
Telephone Number	:	714-842-5593
Fax Number	:	714-842-6198

Provider Business Practice Location Address
First Line	:	6968 WARNER AVE
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-5316
Country	:	US
Telephone Number	:	714-842-5593
Fax Number	:	714-842-6198

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

Provider Enumeration Date	:	11/21/2007
Last Update Date	:	11/21/2007

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