Provider Demographics
NPI:1558542233
Name:THOMPSON, RONALD WAYNE (DDS)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:WAYNE
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 1:6968 WARNER AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-5316
Mailing Address - Country:US
Mailing Address - Phone:714-842-5593
Mailing Address - Fax:714-842-6198
Practice Address - Street 1:6968 WARNER AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-5316
Practice Address - Country:US
Practice Address - Phone:714-842-5593
Practice Address - Fax:714-842-6198
Is Sole Proprietor?:No
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA214121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice