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General NPI Number Information
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NPI Number | 1679974901
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Entity Type | Organization
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Legal Business Name | COMFORT FAMILY DENTAL
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Dates
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Enumeration Date | 09/05/2014
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Last Update Date | 09/05/2014
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Provider Practice Location Address
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Address Line | 2036 W 95TH ST
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City | CHICAGO
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State | IL
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Zip | 60643-1116
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Country | US
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Telephone | 773-366-8718
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Fax | 708-575-6496
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Provider Business Mailing Address
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Address Line | 2036 W 95TH ST
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City | CHICAGO
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State | IL
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Zip | 60643-1116
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Country | US
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Telephone | 773-366-8718
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Fax | 708-575-6496
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. CORIE R ROWE
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Credential | DMD
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Telephone | 773-366-8718
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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 | 019028834
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License Number State | IL
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