Provider Demographics
NPI:1043463375
Name:THOMPSON, RANDALL L (DDS)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:L
Last Name:THOMPSON
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 1:14441 MEMORIAL DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-6744
Mailing Address - Country:US
Mailing Address - Phone:281-497-1842
Mailing Address - Fax:
Practice Address - Street 1:14441 MEMORIAL DR
Practice Address - Street 2:SUITE 3
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-6744
Practice Address - Country:US
Practice Address - Phone:281-497-1842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9556122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist