Organization
PEPSQUAD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEREK THOMPSON (OWNER)
(509) 823-4480
Entity
Organization
Contact information
Practice address
5215 E SOUTHERN AVE, MESA, AZ 85206-2777
(509) 823-4480
(509) 823-4490
Mailing address
4309 W NOB HILL BLVD, YAKIMA, WA 98908-3971
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
122400000X
Denturist
—
—
Other
Enumeration date
05/18/2021
Last updated
05/18/2021
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