Provider Demographics
NPI:1437261930
Name:COMFORT DENTAL FORT COLLINS
Entity Type:Organization
Organization Name:COMFORT DENTAL FORT COLLINS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALOIS
Authorized Official - Middle Name:KARL
Authorized Official - Last Name:TRIPAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-498-8300
Mailing Address - Street 1:934 S LEMAY AVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3207
Mailing Address - Country:US
Mailing Address - Phone:970-498-8300
Mailing Address - Fax:970-498-8333
Practice Address - Street 1:934 S LEMAY AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3207
Practice Address - Country:US
Practice Address - Phone:970-498-8300
Practice Address - Fax:970-498-8333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO75031223G0001X
CO81121223G0001X
CO70431223G0001X
CO91471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO56859376Medicaid