1396023164 NPI number — THOMPSON DMD PLLC

Table of content: (NPI 1396023164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396023164 NPI number — THOMPSON DMD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMPSON DMD PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396023164
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4309 W NOB HILL BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YAKIMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98908-3971
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-823-4480
Provider Business Mailing Address Fax Number:
509-823-4488

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3217 PICARD PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUNNYSIDE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98944-8400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-790-0722
Provider Business Practice Location Address Fax Number:
509-837-2517
Provider Enumeration Date:
07/28/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ANGOTTI
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
509-823-4481

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  60170604 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 60160969 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 10686 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 3855 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 60162008 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 60102410 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 60166205 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223X0400X , with the licence number: 11197 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 9229 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1054937 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2011723 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1091661 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2005801 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2009912 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2003693 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2009645 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2009772 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1010228 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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