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NPI Code Detail

MEDICARE: COMFORT DENTAL GROUP OF NORTHGLENN

MEDICARE: COMFORT DENTAL GROUP OF NORTHGLENN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry104182CO

General Provider Information

NPI Number : 1720133499
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMFORT DENTAL GROUP OF NORTHGLENN
Provider Business Mailing Address
First Line : 10780 WASHINGTON ST
Second Line :
City : NORTHGLENN
State : CO
Zip : 80233-3439
Country : US
Telephone Number : 303-452-6630
Fax Number : 303-252-0237
Provider Business Practice Location Address
First Line : 10780 WASHINGTON ST
Second Line :
City : NORTHGLENN
State : CO
Zip : 80233-3439
Country : US
Telephone Number : 303-452-6630
Fax Number : 303-252-0237
Authorized Official
Title or Position : PARTNER
Name : ROY A MARTIN JR.
Credential : D.D.S
Telephone Number : 303-452-6630
Provider Enumeration Date : 01/24/2007
Last Update Date : 08/22/2020

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