Provider Demographics
NPI:1477597292
Name:THOMPSON, ERNEST ROY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:ROY
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 1:3895 SW 185TH AVE
Mailing Address - Street 2:# 130
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97007
Mailing Address - Country:US
Mailing Address - Phone:503-649-5900
Mailing Address - Fax:503-649-9047
Practice Address - Street 1:3895 SW 185TH AVE
Practice Address - Street 2:# 130
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97007
Practice Address - Country:US
Practice Address - Phone:503-649-5900
Practice Address - Fax:503-649-9047
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR061151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice