Provider Demographics
NPI:1700188703
Name:THOMPSON AND MOORE, D.D.S., P.C.
Entity Type:Organization
Organization Name:THOMPSON AND MOORE, D.D.S., P.C.
Other - Org Name:CAULKS HILL DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:TRES/SEC
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WELDON
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:636-441-3430
Mailing Address - Street 1:1319 CAULKS HILL RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-6863
Mailing Address - Country:US
Mailing Address - Phone:636-441-3430
Mailing Address - Fax:636-441-5987
Practice Address - Street 1:1319 CAULKS HILL RD
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-6863
Practice Address - Country:US
Practice Address - Phone:636-441-3430
Practice Address - Fax:636-441-5987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0139161223G0001X
MO0139541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty