Healthcare Provider Details

I. General information

NPI: 1487152799
Provider Name (Legal Business Name): COMFORT DENTAL INC- HAMIDREZA MADANI DMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6408 THORNBERRY CT STE 120
MASON OH
45040-7841
US

IV. Provider business mailing address

6408 THORNBERRY CT STE 120
MASON OH
45040-7841
US

V. Phone/Fax

Practice location:
  • Phone: 513-398-8777
  • Fax:
Mailing address:
  • Phone: 513-398-8777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number20317
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number20317
License Number StateOH

VIII. Authorized Official

Name: TAMMY WASSON
Title or Position: RECEPTIONIST
Credential:
Phone: 513-398-8777