Provider Demographics
NPI:1821248964
Name:COMFORT DENTAL
Entity Type:Organization
Organization Name:COMFORT DENTAL
Other - Org Name:COMFORT DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:LIZBETH
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:BM
Authorized Official - Phone:401-781-5151
Mailing Address - Street 1:1482 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-2836
Mailing Address - Country:US
Mailing Address - Phone:401-781-5151
Mailing Address - Fax:401-781-5252
Practice Address - Street 1:1482 BROAD ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-2836
Practice Address - Country:US
Practice Address - Phone:401-781-5151
Practice Address - Fax:401-781-5252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI25601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty