Provider Demographics
NPI:1245369206
Name:THOMPSON, TIMOTHY EDWARD (DMD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:EDWARD
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 4TH AVE N
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-6139
Mailing Address - Country:US
Mailing Address - Phone:208-733-2471
Mailing Address - Fax:
Practice Address - Street 1:241 4TH AVE N
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6139
Practice Address - Country:US
Practice Address - Phone:208-733-2471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-18711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice