MEDICARE: COMFORT DENTAL OF BRENTWOOD HILLS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry		NM

General Provider Information

NPI Number	:	1346442167
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMFORT DENTAL OF BRENTWOOD HILLS

Provider Business Mailing Address
First Line	:	2010 JUAN TABO BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-3306
Country	:	US
Telephone Number	:	505-237-2273
Fax Number	:	505-323-9294

Provider Business Practice Location Address
First Line	:	2010 JUAN TABO BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-3306
Country	:	US
Telephone Number	:	505-237-2273
Fax Number	:	505-323-9294

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. BRUCE IRICK
Credential	:	DDS
Telephone Number	:	505-237-2273

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	07/21/2022

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