Provider Demographics
NPI:1770546798
Name:THOMPSON, RANDALL A (DDS)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:A
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 1:8617 280TH ST NW
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-7440
Mailing Address - Country:US
Mailing Address - Phone:360-629-3072
Mailing Address - Fax:360-629-3906
Practice Address - Street 1:810 REKDAL RD
Practice Address - Street 2:
Practice Address - City:CAMANO ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98282-8852
Practice Address - Country:US
Practice Address - Phone:360-629-4097
Practice Address - Fax:360-629-3906
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000044081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice