MEDICARE: COMFORT DENTAL THOUSAND OAKS, 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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1699055012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMFORT DENTAL THOUSAND OAKS, PLLC

Provider Business Mailing Address
First Line	:	3023 THOUSAND OAKS DR
Second Line	:	SUITE 110
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-3556
Country	:	US
Telephone Number	:	210-497-6700
Fax Number	:

Provider Business Practice Location Address
First Line	:	3023 THOUSAND OAKS DR
Second Line	:	SUITE 110
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-3556
Country	:	US
Telephone Number	:	210-497-6700
Fax Number	:

Authorized Official
Title or Position	:	FRONT OFFICE
Name	:	KANDICE SCITERN
Credential	:
Telephone Number	:	210-497-6700

Provider Enumeration Date	:	08/17/2011
Last Update Date	:	08/17/2011

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