Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 16747 | TX |
NPI | 1013132794 |
---|---|
Provider Name | Dr. Mark Thompson |
First Address | Dripping Springs, TX 78620-4993 |
Second Address | Dripping Springs, TX 78620-4993 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2007 |
Last Update Date | 04/10/2016 |