Provider Demographics
NPI:1538513338
Name:SEAN R. THOMPSON DDS PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:SEAN R. THOMPSON DDS PROFESSIONAL CORPORATION
Other - Org Name:OC SMILE SOLUTIONS
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-916-0178
Mailing Address - Street 1:25500 RANCHO NIGUEL RD STE 220
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-7373
Mailing Address - Country:US
Mailing Address - Phone:949-916-0178
Mailing Address - Fax:949-916-0238
Practice Address - Street 1:25500 RANCHO NIGUEL RD STE 220
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-7373
Practice Address - Country:US
Practice Address - Phone:949-916-0178
Practice Address - Fax:949-916-0238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47572122300000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty