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General NPI Number Information
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NPI Number | 1154871820
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Entity Type | Organization
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Legal Business Name | COMFORT HOLD DENTURES LLC
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Dates
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Enumeration Date | 10/06/2016
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Last Update Date | 10/06/2016
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Provider Practice Location Address
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Address Line | 504 N MAIN ST STE B
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City | NICHOLASVILLE
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State | KY
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Zip | 40356-1125
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Country | US
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Telephone | 859-885-0070
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Fax |
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Provider Business Mailing Address
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Address Line | 504 N MAIN ST STE B
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City | NICHOLASVILLE
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State | KY
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Zip | 40356-1125
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | RYAN MICHAEL WILHELM-BLEDSOE
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Credential |
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Telephone | 317-442-9757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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