Healthcare Provider Details

I. General information

NPI: 1386780278
Provider Name (Legal Business Name): KRISTINA LEA COMPTON RDHAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 06/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 CAMINO TASSAJARA
DANVILLE CA
94526-6098
US

IV. Provider business mailing address

2605 CAMINO TASSAJARA UNIT 2495
DANVILLE CA
94526-6032
US

V. Phone/Fax

Practice location:
  • Phone: 925-727-8032
  • Fax:
Mailing address:
  • Phone: 925-727-8032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberHAP55
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: