Provider Demographics
NPI:1538258330
Name:THOMSON, MARK EDWARD (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:THOMSON
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 1:81 BRINKERHOFF ST
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2729
Mailing Address - Country:US
Mailing Address - Phone:518-561-3380
Mailing Address - Fax:518-561-5203
Practice Address - Street 1:81 BRINKERHOFF ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2729
Practice Address - Country:US
Practice Address - Phone:518-561-3380
Practice Address - Fax:518-561-5203
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038589-11223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics