Individual provider Active NPI

Mark Allan Thompson, DDS

  • Dentist
  • Jacksonville, TX
National Provider Identifier
1881776912
Registry record updated Nov 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
12913 Issued in TX
Practice address
701 S Main
Jacksonville, TX 75766
Phone
(903) 586-6829
Fax
(903) 589-3728
NPI assigned
Oct 19, 2006
Last updated
Nov 18, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 12913 TX Primary

Addresses

Primary practice location

701 S Main
Jacksonville, TX 75766

Mailing address

408 Wynn Dr
Jacksonville, TX 75766-4976
Phone (903) 586-6829

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150806009744 TX Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 6507170404

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12913TXMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Hatchett and Thompson DDS Past Accepting new patients
J.Michael Hatchett, DDS, PC Mark Allan Thompson, DDS, PC Dentist Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321574400000",
    "number": "1881776912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 WYNN DR",
            "city": "JACKSONVILLE",
            "state": "TX",
            "postal_code": "757664976",
            "telephone_number": "903-586-6829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 S MAIN",
            "city": "JACKSONVILLE",
            "state": "TX",
            "postal_code": "75766",
            "telephone_number": "903-586-6829",
            "fax_number": "903-589-3728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMPSON",
        "first_name": "MARK",
        "middle_name": "ALLAN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2011-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "12913",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, TX

Sources for this page

Verify at the official NPI Registry.