Provider Demographics
NPI:1053890178
Name:ALANA K. THOMPSON DDS INC.
Entity type:Organization
Organization Name:ALANA K. THOMPSON DDS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALANA
Authorized Official - Middle Name:KVICHAK
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:831-431-6477
Mailing Address - Street 1:1016 SOQUEL AVE # 2
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2104
Mailing Address - Country:US
Mailing Address - Phone:831-431-6477
Mailing Address - Fax:831-471-8265
Practice Address - Street 1:1016 SOQUEL AVE # 2
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2104
Practice Address - Country:US
Practice Address - Phone:831-431-6477
Practice Address - Fax:831-471-8265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52631122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1861402406Medicaid