MEDICARE: ANDREW LEE 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	:	1619237955
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDREW LEE THOMPSON DMD PC & ASSOC.

Provider Business Mailing Address
First Line	:	10395 NW GLENCOE RD STE 100
Second Line	:
City	:	NORTH PLAINS
State	:	OR
Zip	:	97133-8208
Country	:	US
Telephone Number	:	503-647-0055
Fax Number	:	503-647-0033

Provider Business Practice Location Address
First Line	:	10395 NW GLENCOE RD STE 100
Second Line	:
City	:	NORTH PLAINS
State	:	OR
Zip	:	97133-8208
Country	:	US
Telephone Number	:	503-647-0055
Fax Number	:	503-647-0033

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANDREW LEE THOMPSON
Credential	:	DMD
Telephone Number	:	503-647-0055

Provider Enumeration Date	:	05/21/2012
Last Update Date	:	05/24/2012

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