Provider Demographics
NPI:1114142783
Name:CLIFFORD C COMPTON III DDS PA
Entity Type:Organization
Organization Name:CLIFFORD C COMPTON III DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:CLYDE
Authorized Official - Last Name:COMPTON
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-786-8825
Mailing Address - Street 1:913 UNION STREET SOUTH
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025
Mailing Address - Country:US
Mailing Address - Phone:704-786-8825
Mailing Address - Fax:704-786-8823
Practice Address - Street 1:913 UNION STREET SOUTH
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025
Practice Address - Country:US
Practice Address - Phone:704-786-8825
Practice Address - Fax:704-786-8823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC3177122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty