Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 21657 | CA |
NPI | 1013046838 |
---|---|
Provider Name | Dr. Henry Scott Thompson |
First Address | Meadow Vista, CA 95722-9531 |
Second Address | Meadow Vista, CA 95722-9531 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 08/07/2007 |