Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 4346-015 | WI |
N | 213EG0000X | General Practice | 4346-015 | WI |
N | 1223P0700X | Prosthodontist | 4346-015 | WI |
NPI | 1093846610 |
---|---|
Provider Name | Dr. Mark C Thomson |
First Address | Menomonee Falls, WI 53051-2828 |
Second Address | Menomonee Falls, WI 53051-2828 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 08/07/2007 |