Provider Demographics
NPI:1669644225
Name:COMPTON FAMILY DENTISTRY
Entity Type:Organization
Organization Name:COMPTON FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:COMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:706-857-4850
Mailing Address - Street 1:215 FARRAR DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30747-2014
Mailing Address - Country:US
Mailing Address - Phone:706-857-4850
Mailing Address - Fax:
Practice Address - Street 1:215 FARRAR DR
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:GA
Practice Address - Zip Code:30747-2014
Practice Address - Country:US
Practice Address - Phone:706-857-4850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN009717122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1811007099Medicaid
GA1922118199Medicaid
GA1942310107Medicaid