Provider Demographics
NPI:1629056965
Name:THOMPSON, RONALD MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:MARK
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 1:4883 RIDGEWOOD
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49083-9401
Mailing Address - Country:US
Mailing Address - Phone:269-671-4088
Mailing Address - Fax:269-671-4108
Practice Address - Street 1:200 TURWILL LN
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-4277
Practice Address - Country:US
Practice Address - Phone:269-381-4435
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI11921631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice