Provider Demographics
NPI:1346523263
Name:COMFORT DENTAL OF ANDERSON, PC
Entity Type:Organization
Organization Name:COMFORT DENTAL OF ANDERSON, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:STRATMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:765-642-9811
Mailing Address - Street 1:820 E 53RD ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46013-1731
Mailing Address - Country:US
Mailing Address - Phone:765-642-9811
Mailing Address - Fax:
Practice Address - Street 1:820 E 53RD ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46013-1731
Practice Address - Country:US
Practice Address - Phone:765-642-9811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010195122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200248810AMedicaid