Healthcare Provider Details

I. General information

NPI: 1295035095
Provider Name (Legal Business Name): COMFORT DENTAL CENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13031 CENTRAL AVE NE
ALBUQUERQUE NM
87123-3029
US

IV. Provider business mailing address

5820 MENAUL BLVD NE
ALBUQUERQUE NM
87110-3238
US

V. Phone/Fax

Practice location:
  • Phone: 505-872-2772
  • Fax:
Mailing address:
  • Phone: 505-872-2772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER JAMES EHAT
Title or Position: GENERAL PARTNER
Credential: D.D.S.
Phone: 505-872-2772