Healthcare Provider Details

I. General information

NPI: 1912909441
Provider Name (Legal Business Name): KATHY YOHO COMPTON D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 SCOGGINS DR
DEMOREST GA
30535-5355
US

IV. Provider business mailing address

1091 RIVERHAVEN LN
WATKINSVILLE GA
30677-1752
US

V. Phone/Fax

Practice location:
  • Phone: 706-778-7156
  • Fax:
Mailing address:
  • Phone: 706-769-8640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDN010837
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: