Provider Demographics
NPI:1851647853
Name:COMFORT DENTAL SANTA ROSA
Entity Type:Organization
Organization Name:COMFORT DENTAL SANTA ROSA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:FARRUGIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:850-505-0500
Mailing Address - Street 1:2010 US HIGHWAY 98 W
Mailing Address - Street 2:#102
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-5345
Mailing Address - Country:US
Mailing Address - Phone:850-254-9577
Mailing Address - Fax:
Practice Address - Street 1:2010 US HIGHWAY 98 W
Practice Address - Street 2:#102
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-5345
Practice Address - Country:US
Practice Address - Phone:850-254-9577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-27
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14033122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty