Provider Demographics
NPI:1013547116
Name:COMFORT ORTHODONTICS PC
Entity Type:Organization
Organization Name:COMFORT ORTHODONTICS PC
Other - Org Name:DOLPHIN BRACES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-274-7071
Mailing Address - Street 1:1702 US HIGHWAY 181 STE A8
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78374-3588
Mailing Address - Country:US
Mailing Address - Phone:361-643-2255
Mailing Address - Fax:361-643-2288
Practice Address - Street 1:1702 US HIGHWAY 181 STE A8
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TX
Practice Address - Zip Code:78374-3588
Practice Address - Country:US
Practice Address - Phone:361-643-2255
Practice Address - Fax:361-643-2288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-17
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty