Provider Demographics
NPI:1235365602
Name:BEAVERTON TENDERCARE
Entity Type:Organization
Organization Name:BEAVERTON TENDERCARE
Other - Org Name:R. W. THOMPSON DMD,PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LENNIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-643-4719
Mailing Address - Street 1:4095 SW 144TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2368
Mailing Address - Country:US
Mailing Address - Phone:503-643-4719
Mailing Address - Fax:503-626-9488
Practice Address - Street 1:4095 SW 144TH AVE STE A
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2368
Practice Address - Country:US
Practice Address - Phone:503-643-4719
Practice Address - Fax:503-626-9488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD69601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty