Provider Demographics
NPI:1689157984
Name:COMPTON DENTALCARE
Entity Type:Organization
Organization Name:COMPTON DENTALCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:COMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-867-5472
Mailing Address - Street 1:15626 SPRING MILL RD
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-9671
Mailing Address - Country:US
Mailing Address - Phone:317-867-5472
Mailing Address - Fax:317-867-4641
Practice Address - Street 1:15626 SPRING MILL RD
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-9671
Practice Address - Country:US
Practice Address - Phone:317-867-5472
Practice Address - Fax:317-867-4641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100201700AMedicaid