MEDICARE: DR. RANDALL A 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	DE00004408	WA

General Provider Information

NPI Number	:	1770546798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDALL A THOMPSON DDS

Provider Business Mailing Address
First Line	:	8617 280TH ST NW
Second Line	:
City	:	STANWOOD
State	:	WA
Zip	:	98292-7440
Country	:	US
Telephone Number	:	360-629-3072
Fax Number	:	360-629-3906

Provider Business Practice Location Address
First Line	:	810 REKDAL RD
Second Line	:
City	:	CAMANO ISLAND
State	:	WA
Zip	:	98282-8852
Country	:	US
Telephone Number	:	360-629-4097
Fax Number	:	360-629-3906

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

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	07/08/2007

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