Provider Demographics
NPI:1679704647
Name:COMFORT CARE DENTAL OF IDAHO FALLS, PLLC
Entity Type:Organization
Organization Name:COMFORT CARE DENTAL OF IDAHO FALLS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:208-524-2300
Mailing Address - Street 1:3550 WASHINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-4968
Mailing Address - Country:US
Mailing Address - Phone:208-524-2300
Mailing Address - Fax:208-545-8447
Practice Address - Street 1:3550 WASHINGTON PKWY
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-4968
Practice Address - Country:US
Practice Address - Phone:208-524-2300
Practice Address - Fax:208-545-8447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-07
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD4056261QD0000X
IDD4164261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental