Provider Demographics
NPI:1104174374
Name:COMPASS DENTAL, P.C.
Entity type:Organization
Organization Name:COMPASS DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUSA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:785-979-5147
Mailing Address - Street 1:2348 N LISTER AVE
Mailing Address - Street 2:#407
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2994
Mailing Address - Country:US
Mailing Address - Phone:785-979-5147
Mailing Address - Fax:
Practice Address - Street 1:4413 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5403
Practice Address - Country:US
Practice Address - Phone:785-979-5147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty