Provider Demographics
NPI:1013256874
Name:LOUISVILLE DENTAL PROF. LLP
Entity Type:Organization
Organization Name:LOUISVILLE DENTAL PROF. LLP
Other - Org Name:COMFORT DENTAL LOUISVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:LEARY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-673-0500
Mailing Address - Street 1:339 MCCASLIN BLVD
Mailing Address - Street 2:UNIT B
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-2914
Mailing Address - Country:US
Mailing Address - Phone:303-673-0500
Mailing Address - Fax:303-673-0505
Practice Address - Street 1:994 W DILLON RD STE 400
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-8404
Practice Address - Country:US
Practice Address - Phone:303-673-5000
Practice Address - Fax:303-673-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-13
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO104801223G0001X
CO98721223G0001X
CO94871223G0001X
CO100691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty