1063549699 NPI number — DR. ERIC A COMPTON DDS

Table of content: DR. ERIC A COMPTON DDS (NPI 1063549699)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063549699 NPI number — DR. ERIC A COMPTON DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COMPTON
Provider First Name:
ERIC
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063549699
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 FRAN LIN PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUNSTER
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46321-3540
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-836-0460
Provider Business Mailing Address Fax Number:
219-836-1174

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 FRAN LIN PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUNSTER
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46321-3540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-836-0460
Provider Business Practice Location Address Fax Number:
219-836-1174
Provider Enumeration Date:
02/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  12008778 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: BC0496972 . This is a "FED CONTROLLED SUBSTANCE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 12008778 . This is a "STATE DENTAL LICENSE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 43000134A . This is a "DENTAL ANESTHESIA PERMIT" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 13008778B . This is a "CONTOLLED SUBSTANCE REGIS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com