Provider Demographics
NPI:1669642765
Name:THOMPSON, DANIEL ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ALLEN
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 1:4835 WINDING WAY
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-9118
Mailing Address - Country:US
Mailing Address - Phone:408-667-6704
Mailing Address - Fax:
Practice Address - Street 1:4835 WINDING WAY
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-9118
Practice Address - Country:US
Practice Address - Phone:408-667-6704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 27698122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist