Provider Demographics
NPI:1457959934
Name:COMFORTABLE DENTISTRY 4U - COTTONWOOD, LLC
Entity Type:Organization
Organization Name:COMFORTABLE DENTISTRY 4U - COTTONWOOD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:505-610-4531
Mailing Address - Street 1:3613 NM 528 NW STE D
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-8918
Mailing Address - Country:US
Mailing Address - Phone:505-899-7645
Mailing Address - Fax:
Practice Address - Street 1:3613 NM 528 NW STE D
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-8918
Practice Address - Country:US
Practice Address - Phone:505-899-7645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-15
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty