Provider Demographics
NPI:1790921807
Name:COMFORT DENTAL CENTENNIAL
Entity Type:Organization
Organization Name:COMFORT DENTAL CENTENNIAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANNNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-689-2273
Mailing Address - Street 1:8223 S QUEBEC ST
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-4415
Mailing Address - Country:US
Mailing Address - Phone:303-689-2273
Mailing Address - Fax:
Practice Address - Street 1:8223 S QUEBEC ST
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-4415
Practice Address - Country:US
Practice Address - Phone:303-689-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO66474311Medicaid