Healthcare Provider Details

I. General information

NPI: 1457959934
Provider Name (Legal Business Name): COMFORTABLE DENTISTRY 4U - COTTONWOOD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 10/16/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3613 NM 528 NW STE D
ALBUQUERQUE NM
87114-8918
US

IV. Provider business mailing address

3613 NM 528 NW STE D
ALBUQUERQUE NM
87114-8918
US

V. Phone/Fax

Practice location:
  • Phone: 505-899-7645
  • Fax:
Mailing address:
  • Phone: 505-899-7645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT H MOSS
Title or Position: CEO
Credential: JD
Phone: 505-610-4531