Provider Demographics
NPI:1144388075
Name:RANDALL A THOMPSON DDS PS
Entity Type:Organization
Organization Name:RANDALL A THOMPSON DDS PS
Other - Org Name:CAMANO ISLAND DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CHAIRMAN OF THE BOARD
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDELL
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-629-4097
Mailing Address - Street 1:810 REKDAL RD
Mailing Address - Street 2:
Mailing Address - City:CARMANO ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98282
Mailing Address - Country:US
Mailing Address - Phone:360-629-4097
Mailing Address - Fax:360-629-3906
Practice Address - Street 1:810 REKDAL RD
Practice Address - Street 2:
Practice Address - City:CARMANO ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98282
Practice Address - Country:US
Practice Address - Phone:360-629-4097
Practice Address - Fax:360-629-3906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00004408122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5030911OtherDSHS