| Organization Name: | COMPASSIONATE DENTISTRY, P.C. |
| NPI Number: | 1063658631 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SCOTT B BOLTZ (OWNER) |
| Mailing Address: | 604 E Boulevard Suite B Kokomo |
| State: | IN US |
| Postal Code: | 469022200 |
| Phone Number: | 7658642328 |
| Fax Number: | 7658642333 |
| NPI Enumeration Date: | 01/01/2009 |
| NPI Last Update Date: | 01/01/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 12008297A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |