NPIMap

Organization Active NPI

Derek Thompson DMD Patrick Ferguson DDS PLLC

Doing business as Yakima Family Dental

  • Oral and Maxillofacial Surgery (Dentist)
  • Union Gap, WA
National Provider Identifier
1740618925
Registry record updated Oct 24, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
DE00009045 Issued in WA
Legal business name
DEREK THOMPSON DMD PATRICK FERGUSON DDS PLLC
Doing business as
Yakima Family Dental
Practice address
2100 S 14TH St
Union Gap, WA 98903-1252
Phone
(509) 457-6300
NPI assigned
Oct 24, 2013
Last updated
Oct 24, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. David Angotti
Title
Cfo
Phone
(509) 823-4481

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X DE00009045 WA Primary

Addresses

Primary practice location

2100 S 14TH St
Union Gap, WA 98903-1252

Mailing address

4309 W Nob Hill Blvd
Yakima, WA 98908-3971

Other identifiers 1

IdentifierTypeStateIssuer
2012717MedicaidWA

Other names 1

  • Yakima Family Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Derek Thompson DMD Patrick Ferguson DDS6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1382572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1382572800000",
    "number": "1740618925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4309 W NOB HILL BLVD",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989083971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 S 14TH ST",
            "city": "UNION GAP",
            "state": "WA",
            "postal_code": "989031252",
            "telephone_number": "509-457-6300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEREK THOMPSON DMD PATRICK FERGUSON DDS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-24",
        "last_updated": "2013-10-24",
        "status": "A",
        "authorized_official_last_name": "ANGOTTI",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "509-823-4481",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WA",
            "license": "DE00009045",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2012717",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Yakima Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Union Gap, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.