Provider Demographics
NPI:1053463182
Name:DAVID I THOMPSON DDS & ASSOC
Entity Type:Organization
Organization Name:DAVID I THOMPSON DDS & ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:IAN
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-736-3602
Mailing Address - Street 1:1309 SO MARY AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-3053
Mailing Address - Country:US
Mailing Address - Phone:408-736-3602
Mailing Address - Fax:408-736-3061
Practice Address - Street 1:1309 SO MARY AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-3053
Practice Address - Country:US
Practice Address - Phone:408-736-3602
Practice Address - Fax:408-736-3061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA318731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9373201Medicaid