Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 21670 | TX |
NPI | 1124244678 |
---|---|
Provider Name | Dr. Aaron Thompson |
First Address | Garland, TX 75040-2742 |
Second Address | Garland, TX 75040-2742 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 08/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
21670 | STATE DENTAL LICENSE (01) | TX |