Provider Demographics
NPI:1730341827
Name:THOMASON, CHRISTOPHER A (DMD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:A
Last Name:THOMASON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 STIERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-5163
Mailing Address - Country:US
Mailing Address - Phone:208-939-4111
Mailing Address - Fax:
Practice Address - Street 1:151 STIERMAN WAY
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-5163
Practice Address - Country:US
Practice Address - Phone:208-939-4111
Practice Address - Fax:208-939-3701
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD41361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice