Provider Demographics
NPI:1386219160
Name:COMFORT DENTAL LEES SUMMIT
Entity Type:Organization
Organization Name:COMFORT DENTAL LEES SUMMIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-521-1312
Mailing Address - Street 1:1221 NE BEACON AVE
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-8454
Mailing Address - Country:US
Mailing Address - Phone:816-521-1312
Mailing Address - Fax:
Practice Address - Street 1:1153 NE RICE RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-6788
Practice Address - Country:US
Practice Address - Phone:816-477-7070
Practice Address - Fax:816-477-7088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty