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General NPI Number Information
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NPI Number | 1770008575
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Entity Type | Individual
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Provider Name | IAN WELCH COMPTON DDS
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Gender | Male
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Dates
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Enumeration Date | 08/14/2017
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Last Update Date | 01/23/2020
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Provider Practice Location Address
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Address Line | 300 W BROADWAY STE 30
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-9053
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Country | US
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Telephone | 712-256-9639
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Fax | 712-256-9690
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Provider Business Mailing Address
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Address Line | 6512 DECATUR ST
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City | OMAHA
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State | NE
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Zip | 68104-4736
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Country | US
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Telephone | 503-367-2686
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7398
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DDS-09530
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License Number State | IA
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