Provider Demographics
NPI:1629484134
Name:COMFORT DENTAL - CONIFER
Entity Type:Organization
Organization Name:COMFORT DENTAL - CONIFER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TENIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SEIFERT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:303-838-2811
Mailing Address - Street 1:25597 CONIFER RD
Mailing Address - Street 2:STE100
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433-9066
Mailing Address - Country:US
Mailing Address - Phone:303-838-2811
Mailing Address - Fax:303-838-0041
Practice Address - Street 1:25597 CONIFER RD
Practice Address - Street 2:STE100
Practice Address - City:CONIFER
Practice Address - State:CO
Practice Address - Zip Code:80433-9066
Practice Address - Country:US
Practice Address - Phone:303-838-2811
Practice Address - Fax:303-838-0041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-03
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO93651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO44338546Medicaid