Provider Demographics
NPI:1477210193
Name:COMSTOCK, MACKENZIE DOROSE
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:DOROSE
Last Name:COMSTOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14237 W ILIFF AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-5421
Mailing Address - Country:US
Mailing Address - Phone:303-870-5312
Mailing Address - Fax:
Practice Address - Street 1:14237 W ILIFF AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-5421
Practice Address - Country:US
Practice Address - Phone:303-870-5312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program