Provider Demographics
NPI:1093839292
Name:CROMPTON, MARK ELLIOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ELLIOTT
Last Name:CROMPTON
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 1:505 SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-2228
Mailing Address - Country:US
Mailing Address - Phone:541-386-3848
Mailing Address - Fax:
Practice Address - Street 1:505 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-2228
Practice Address - Country:US
Practice Address - Phone:541-386-3848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD64931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice