Provider Demographics
NPI:1336433937
Name:WADE D THOMPSON DDS MS PC
Entity Type:Organization
Organization Name:WADE D THOMPSON DDS MS PC
Other - Org Name:THOMPSON ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WADE
Authorized Official - Middle Name:DAINES
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:801-375-7088
Mailing Address - Street 1:380 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-4659
Mailing Address - Country:US
Mailing Address - Phone:801-375-7088
Mailing Address - Fax:801-375-4777
Practice Address - Street 1:380 W CENTER ST
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-4659
Practice Address - Country:US
Practice Address - Phone:801-375-7088
Practice Address - Fax:801-375-4777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5823982-99211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty