Provider Demographics
NPI:1609139807
Name:COMFORT DENTAL CARE OF DOTHAN LLC
Entity Type:Organization
Organization Name:COMFORT DENTAL CARE OF DOTHAN LLC
Other - Org Name:ALABAMA COMFORT DENTAL OF DOTHAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LEAD DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DENTREMONT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:334-792-3838
Mailing Address - Street 1:4440 W MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-1178
Mailing Address - Country:US
Mailing Address - Phone:334-792-3838
Mailing Address - Fax:334-792-6910
Practice Address - Street 1:4440 W MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1178
Practice Address - Country:US
Practice Address - Phone:334-792-3838
Practice Address - Fax:334-792-6910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4021122300000X
AL3619122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51595942OtherBLUE CROSS BLUE SHIELD
AL009967145Medicaid