Provider Demographics
NPI:1154503449
Name:THOMPSON, ROGELIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROGELIO
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 S I ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-4660
Mailing Address - Country:US
Mailing Address - Phone:559-662-1410
Mailing Address - Fax:559-662-1455
Practice Address - Street 1:509 S I ST
Practice Address - Street 2:SUITE D
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-4660
Practice Address - Country:US
Practice Address - Phone:559-662-1410
Practice Address - Fax:559-662-1455
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA404001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice