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General NPI Number Information
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NPI Number | 1770593519
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Entity Type | Organization
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Legal Business Name | COMFORT DENTAL THOMPSON VALLEY
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 03/07/2011
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Provider Practice Location Address
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Address Line | 1405 10TH ST SW
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City | LOVELAND
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State | CO
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Zip | 80537-2301
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Country | US
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Telephone | 970-962-9995
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Fax | 970-461-0693
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Provider Business Mailing Address
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Address Line | 1405 10TH ST SW
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City | LOVELAND
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State | CO
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Zip | 80537-2301
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Country | US
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Telephone | 970-962-9995
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Fax | 970-461-0693
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Authorized Official
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Title or Position | MANAGING MEMBER/DENTIST
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Name | DR. JOHN FILLMORE
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Credential | DDS
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Telephone | 970-962-9995
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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 | 9088
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License Number State | CO
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