Healthcare Provider Details

I. General information

NPI: 1265500086
Provider Name (Legal Business Name): COMFORT DENTAL WHEATRIDGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 11/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9990 W 26TH AVE SUITE 100
LAKEWOOD CO
80215
US

IV. Provider business mailing address

9990 W 26TH AVE SUITE 100
LAKEWOOD CO
80215
US

V. Phone/Fax

Practice location:
  • Phone: 303-232-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SARA DANETTE BACHICHA
Title or Position: OFFICE MANAGER
Credential:
Phone: 303-232-4500