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General NPI Number Information
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NPI Number | 1790196368
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Entity Type | Organization
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Legal Business Name | COMPASS DENTAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 05/16/2014
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Last Update Date | 05/16/2014
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Provider Practice Location Address
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Address Line | 2801 WADE HAMPTON BLVD SUITE 118
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City | TAYLORS
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State | SC
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Zip | 29687-2781
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Country | US
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Telephone | 864-715-0688
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Fax |
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Provider Business Mailing Address
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Address Line | 2801 WADE HAMPTON BLVD SUITE 118
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City | TAYLORS
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State | SC
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Zip | 29687-2781
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JASON SCOTT ROGERS
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Credential | DMD
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Telephone | 864-200-1999
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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 | 4024
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License Number State | SC
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