Provider Demographics
NPI:1114296944
Name:COMFORT H DENTAL LLC
Entity Type:Organization
Organization Name:COMFORT H DENTAL LLC
Other - Org Name:WOODBRIDGE FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HASSANOOR
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDIRAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-986-0434
Mailing Address - Street 1:13601 OFFICE PL
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4213
Mailing Address - Country:US
Mailing Address - Phone:703-986-0434
Mailing Address - Fax:
Practice Address - Street 1:13601 OFFICE PL
Practice Address - Street 2:SUITE 202
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4213
Practice Address - Country:US
Practice Address - Phone:703-986-0434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014123941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty