Provider Demographics
NPI:1295833184
Name:THOMPSON, PAUL A (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
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 1:4526 RINETTI LN
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-3359
Mailing Address - Country:US
Mailing Address - Phone:818-790-5220
Mailing Address - Fax:818-790-5227
Practice Address - Street 1:4526 RINETTI LN
Practice Address - Street 2:
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-3359
Practice Address - Country:US
Practice Address - Phone:818-790-5220
Practice Address - Fax:818-790-5227
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA383751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA38375OtherLICENSE NO.