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General NPI Number Information
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NPI Number | 1629216049
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Entity Type | Organization
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Legal Business Name | COMFORT DENTAL ASSOCIATES PC
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Dates
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Enumeration Date | 01/22/2009
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Last Update Date | 10/10/2014
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Provider Practice Location Address
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Address Line | 9263 OLD KEENE MILL RD
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City | BURKE
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State | VA
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Zip | 22015-4202
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Country | US
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Telephone | 703-455-3338
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Fax |
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Provider Business Mailing Address
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Address Line | 9263 OLD KEENE MILL RD
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City | BURKE
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State | VA
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Zip | 22015-4202
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Country | US
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Telephone | 703-455-3338
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CINDY DEWITT
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Credential |
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Telephone | 703-455-3338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401410761
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 401411147
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License Number State | VA
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