Provider Demographics
NPI:1326276205
Name:COMFORT DENTAL CLAY MATHIS, PLLC
Entity Type:Organization
Organization Name:COMFORT DENTAL CLAY MATHIS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BULLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:972-222-5313
Mailing Address - Street 1:540 CLAY MATHIS RD
Mailing Address - Street 2:110
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75181-1167
Mailing Address - Country:US
Mailing Address - Phone:972-222-5313
Mailing Address - Fax:
Practice Address - Street 1:540 CLAY MATHIS RD
Practice Address - Street 2:110
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75181-1167
Practice Address - Country:US
Practice Address - Phone:972-222-5313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX243121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty