Provider Demographics
NPI:1013132794
Name:THOMPSON, MARK (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27490 RANCH ROAD 12
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-4993
Mailing Address - Country:US
Mailing Address - Phone:512-858-2916
Mailing Address - Fax:
Practice Address - Street 1:27490 RANCH ROAD 12
Practice Address - Street 2:SUITE 1
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-4993
Practice Address - Country:US
Practice Address - Phone:512-858-2916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX167471223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics