Provider Demographics
NPI:1417009861
Name:MARLENE M THOMPSON D D S INC
Entity Type:Organization
Organization Name:MARLENE M THOMPSON D D S INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:MAVILA
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-740-2595
Mailing Address - Street 1:1018 W EL NORTE PKWY
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-3339
Mailing Address - Country:US
Mailing Address - Phone:760-740-2595
Mailing Address - Fax:760-740-2596
Practice Address - Street 1:1018 W EL NORTE PKWY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026-3339
Practice Address - Country:US
Practice Address - Phone:760-740-2595
Practice Address - Fax:760-740-2596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA503821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty