Healthcare Provider Details

I. General information

NPI: 1407410020
Provider Name (Legal Business Name): PATRICIA R. COMSTOCK RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 11/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 S NEVADA AVE
MONTROSE CO
81401-4234
US

IV. Provider business mailing address

3132 MONTE VISTA CIR
MONTROSE CO
81401
US

V. Phone/Fax

Practice location:
  • Phone: 970-787-9647
  • Fax: 970-787-9696
Mailing address:
  • Phone: 970-596-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2139
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: