Provider Demographics
NPI:1457490526
Name:HARRIS, FRANK COMPTON (LD)
Entity Type:Individual
Prefix:MR
First Name:FRANK
Middle Name:COMPTON
Last Name:HARRIS
Suffix:
Gender:M
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-2226
Mailing Address - Country:US
Mailing Address - Phone:208-785-1307
Mailing Address - Fax:208-782-3546
Practice Address - Street 1:390 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-2226
Practice Address - Country:US
Practice Address - Phone:208-785-1307
Practice Address - Fax:208-782-3546
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLD-05122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist