Provider Demographics
NPI:1023746286
Name:COMSTOCK, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:COMSTOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 N STATE ROAD 135 STE A1
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-1349
Mailing Address - Country:US
Mailing Address - Phone:317-667-0348
Mailing Address - Fax:
Practice Address - Street 1:1001 N STATE ROAD 135 STE A1
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1349
Practice Address - Country:US
Practice Address - Phone:317-667-0348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013416A1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0OtherN/A