Provider Demographics
NPI:1598008880
Name:THOMPSON. FERGUSON. STEINHART. JAMES, PLLC
Entity Type:Organization
Organization Name:THOMPSON. FERGUSON. STEINHART. JAMES, PLLC
Other - Org Name:APPLE VALLEY DENTAL AND ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:509-823-4480
Mailing Address - Street 1:4309 W NOB HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3971
Mailing Address - Country:US
Mailing Address - Phone:509-823-4480
Mailing Address - Fax:
Practice Address - Street 1:6525 BURDEN BOULEVARD
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301
Practice Address - Country:US
Practice Address - Phone:509-823-4480
Practice Address - Fax:509-823-4488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-04
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60102410122300000X
WADE60232759122300000X
WADE60166205122300000X
WADE00009229122300000X
WADE60293839122300000X
WADE60232173122300000X
WADE00010686122300000X
WADE60170604122300000X
WADE000111971223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1091661Medicaid
WA2013650Medicaid
WA2017327Medicaid
WA2020875Medicaid
WA2003693Medicaid
WA2011723Medicaid
WA2005801Medicaid
WA2009912Medicaid
WA1054937Medicaid