Provider Demographics
NPI:1407976335
Name:COMFORT DENTAL CARE
Entity Type:Organization
Organization Name:COMFORT DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANTOOTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-271-2000
Mailing Address - Street 1:8853 ROCKVILLE RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-2731
Mailing Address - Country:US
Mailing Address - Phone:317-271-2000
Mailing Address - Fax:317-271-2900
Practice Address - Street 1:8853 ROCKVILLE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46234-2731
Practice Address - Country:US
Practice Address - Phone:317-271-2000
Practice Address - Fax:317-271-2900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009124A1223G0001X
IN12009568A1223G0001X
IN12010071A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty