Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 30845 | CA |
NPI | 1033207444 |
---|---|
Provider Name | Dr. Kurt Wade Thompson |
First Address | Folsom, CA 95630 |
Second Address | Folsom, CA 95630 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 08/07/2007 |