Provider Demographics
NPI:1285181131
Name:THOMSON ORTHODONTICS
Entity Type:Organization
Organization Name:THOMSON ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:BRADY
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:435-752-1320
Mailing Address - Street 1:1445 N 400 E STE 3
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-7564
Mailing Address - Country:US
Mailing Address - Phone:435-752-1320
Mailing Address - Fax:435-750-6432
Practice Address - Street 1:1445 N 400 E STE 3
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-7564
Practice Address - Country:US
Practice Address - Phone:435-752-1320
Practice Address - Fax:435-750-6432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT48047721223X0400X
UT80414581223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1821130253OtherINDIVIDUAL NPI
UT1912998725OtherINDIVIDUAL NPI