Provider Demographics
NPI:1588803324
Name:PEDO ONE, PROF. LLC
Entity Type:Organization
Organization Name:PEDO ONE, PROF. LLC
Other - Org Name:COMFORT DENTAL KIDS NORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-252-4050
Mailing Address - Street 1:9652 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-2160
Mailing Address - Country:US
Mailing Address - Phone:303-252-4050
Mailing Address - Fax:
Practice Address - Street 1:9652 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-2160
Practice Address - Country:US
Practice Address - Phone:303-252-4050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-18
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty