Provider Demographics
NPI:1063549699
Name:COMPTON, ERIC A (DDS)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:A
Last Name:COMPTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:219-836-0460
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:219-836-0460
Practice Address - Fax:219-836-1174
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120087781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
INBC0496972OtherFED CONTROLLED SUBSTANCE
IN12008778OtherSTATE DENTAL LICENSE
IN43000134AOtherDENTAL ANESTHESIA PERMIT
IN13008778BOtherCONTOLLED SUBSTANCE REGIS