Provider Demographics
NPI:1366707796
Name:THOMPSON, SCOTT RICHARD (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:RICHARD
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 N DEVON WAY
Mailing Address - Street 2:
Mailing Address - City:STAR
Mailing Address - State:ID
Mailing Address - Zip Code:83669-5689
Mailing Address - Country:US
Mailing Address - Phone:208-631-7485
Mailing Address - Fax:208-895-8555
Practice Address - Street 1:6700 N LINDER RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-6606
Practice Address - Country:US
Practice Address - Phone:208-895-8555
Practice Address - Fax:208-895-8555
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD3717122300000X
IDD4470122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist