Provider Demographics
NPI:1063658631
Name:COMPASSIONATE DENTISTRY, P.C.
Entity Type:Organization
Organization Name:COMPASSIONATE DENTISTRY, P.C.
Other - Org Name:SCOTT B. BOLTZ, DDS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:B
Authorized Official - Last Name:BOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:765-864-2328
Mailing Address - Street 1:604 E BOULEVARD
Mailing Address - Street 2:SUITE B
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-2200
Mailing Address - Country:US
Mailing Address - Phone:765-864-2328
Mailing Address - Fax:765-864-2333
Practice Address - Street 1:604 E BOULEVARD
Practice Address - Street 2:SUITE B
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-2200
Practice Address - Country:US
Practice Address - Phone:765-864-2328
Practice Address - Fax:765-864-2333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-01
Last Update Date:2009-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008297A261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental