Provider Demographics
NPI:1295745701
Name:THOMPSON, DAVID IAN (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:IAN
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 1:1309 SO MARY AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-3053
Mailing Address - Country:US
Mailing Address - Phone:408-736-3602
Mailing Address - Fax:408-736-3061
Practice Address - Street 1:1309 SO MARY AVE
Practice Address - Street 2:STE 105
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-3053
Practice Address - Country:US
Practice Address - Phone:408-736-3602
Practice Address - Fax:408-736-3061
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA318731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9373201Medicaid