Provider Demographics
NPI:1679974901
Name:COMFORT FAMILY DENTAL
Entity Type:Organization
Organization Name:COMFORT FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CORIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROWE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:773-366-8718
Mailing Address - Street 1:2036 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-1116
Mailing Address - Country:US
Mailing Address - Phone:773-366-8718
Mailing Address - Fax:708-575-6496
Practice Address - Street 1:2036 W 95TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-1116
Practice Address - Country:US
Practice Address - Phone:773-366-8718
Practice Address - Fax:708-575-6496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028834122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1568746048OtherNPI