Provider Demographics
NPI:1508273269
Name:LONGMONT DENTAL PARTNERS, LLC.
Entity Type:Organization
Organization Name:LONGMONT DENTAL PARTNERS, LLC.
Other - Org Name:COMFORT DENTAL LONGMONT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:MORTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-678-7783
Mailing Address - Street 1:1751 HOVER ST
Mailing Address - Street 2:SUITE A-2
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-7140
Mailing Address - Country:US
Mailing Address - Phone:303-679-7783
Mailing Address - Fax:303-532-2287
Practice Address - Street 1:1751 HOVER ST
Practice Address - Street 2:SUITE A-2
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-7140
Practice Address - Country:US
Practice Address - Phone:303-679-7783
Practice Address - Fax:303-532-2287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-15
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO67501761Medicaid