Provider Demographics
NPI:1407410020
Name:COMSTOCK, PATRICIA R (RDH)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:R
Last Name:COMSTOCK
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3132 MONTE VISTA CIR
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401
Mailing Address - Country:US
Mailing Address - Phone:970-596-8400
Mailing Address - Fax:
Practice Address - Street 1:230 S NEVADA AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4234
Practice Address - Country:US
Practice Address - Phone:970-787-9647
Practice Address - Fax:970-787-9696
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-29
Last Update Date:2019-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2139124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist