Provider Demographics
NPI:1225038003
Name:THOMPSON, ANDREW L (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:L
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4074 NW SALTZMAN RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-2423
Mailing Address - Country:US
Mailing Address - Phone:503-629-8005
Mailing Address - Fax:503-629-9775
Practice Address - Street 1:4074 NW SALTZMAN RD
Practice Address - Street 2:SUITE 107
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-2423
Practice Address - Country:US
Practice Address - Phone:503-629-8005
Practice Address - Fax:503-629-9775
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-22
Last Update Date:2007-07-08
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
ORD7612122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist