Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 16235 | MI |
NPI | 1053470203 |
---|---|
Provider Name | Mr. Frederick J Thompson |
First Address | Grand Blanc, MI 48439 |
Second Address | Grand Blanc, MI 48439 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 08/07/2007 |