Provider Demographics
NPI:1780041731
Name:COMPTON AND BROOMHEAD DENTAL CENTER, LLC
Entity Type:Organization
Organization Name:COMPTON AND BROOMHEAD DENTAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:A
Authorized Official - Last Name:COMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-836-0881
Mailing Address - Street 1:901 FRAN LIN PKWY
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-3540
Mailing Address - Country:US
Mailing Address - Phone:219-836-0881
Mailing Address - Fax:219-836-1174
Practice Address - Street 1:901 FRAN LIN PKWY
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3540
Practice Address - Country:US
Practice Address - Phone:219-836-0881
Practice Address - Fax:219-836-1174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INXF900678261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental