Healthcare Provider Details

I. General information

NPI: 1992099964
Provider Name (Legal Business Name): DAVID W. COMPTON, DMD, MS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10163 SE SUNNYSIDE RD SUITE 450
CLACKAMAS OR
97015-5743
US

IV. Provider business mailing address

10163 SE SUNNYSIDE RD SUITE 450
CLACKAMAS OR
97015-5743
US

V. Phone/Fax

Practice location:
  • Phone: 503-652-2615
  • Fax: 503-654-7561
Mailing address:
  • Phone: 503-652-2615
  • Fax: 503-654-7561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MARY COMPTON
Title or Position: OFFICE MANAGER
Credential:
Phone: 503-652-2615