Provider Demographics
NPI:1275938334
Name:COMPREHENSIVE DENTAL GROUP, LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE DENTAL GROUP, LLC
Other - Org Name:HAMMERLEE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER AND MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:HAMMERLEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:814-868-3647
Mailing Address - Street 1:5158 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-2489
Mailing Address - Country:US
Mailing Address - Phone:814-868-3647
Mailing Address - Fax:814-864-2715
Practice Address - Street 1:5158 PEACH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-2489
Practice Address - Country:US
Practice Address - Phone:814-868-3647
Practice Address - Fax:814-864-2715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty