Provider Demographics
NPI:1982086856
Name:COMFORT CARE DENTAL
Entity Type:Organization
Organization Name:COMFORT CARE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:CZYZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-233-5362
Mailing Address - Street 1:485 E ALAMEDA RD
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-3609
Mailing Address - Country:US
Mailing Address - Phone:208-233-5362
Mailing Address - Fax:208-234-8056
Practice Address - Street 1:485 E ALAMEDA RD
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-3609
Practice Address - Country:US
Practice Address - Phone:208-233-5362
Practice Address - Fax:208-234-8056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty