MEDICARE: COLORADO COMFORT KIDS DENTISTRY PLLC

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	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1497532170
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO COMFORT KIDS DENTISTRY PLLC

Provider Business Mailing Address
First Line	:	9998 W COLFAX AVE UNIT 104
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80215-3926
Country	:	US
Telephone Number	:	720-823-4460
Fax Number	:

Provider Business Practice Location Address
First Line	:	9998 W COLFAX AVE UNIT 104
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80215-3926
Country	:	US
Telephone Number	:	720-823-4460
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	CHANTRA NEIT
Credential	:
Telephone Number	:	720-717-9328

Provider Enumeration Date	:	09/14/2023
Last Update Date	:	09/14/2023

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