Provider Demographics
NPI:1760819619
Name:COMFORT DENTAL
Entity Type:Organization
Organization Name:COMFORT DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:HIBA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KELLOW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-331-0701
Mailing Address - Street 1:5305 S 96TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-3317
Mailing Address - Country:US
Mailing Address - Phone:402-331-0701
Mailing Address - Fax:402-331-7130
Practice Address - Street 1:5305 S 96TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-3317
Practice Address - Country:US
Practice Address - Phone:402-331-0701
Practice Address - Fax:402-331-7130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-08
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty