Provider Demographics
NPI:1194088385
Name:COMFORT DENTAL OF DOTHAN LLC
Entity type:Organization
Organization Name:COMFORT DENTAL OF DOTHAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:334-792-3838
Mailing Address - Street 1:4440 W MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-1186
Mailing Address - Country:US
Mailing Address - Phone:334-792-3838
Mailing Address - Fax:334-792-6910
Practice Address - Street 1:4440 W MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1186
Practice Address - Country:US
Practice Address - Phone:334-792-3838
Practice Address - Fax:334-792-6910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL36191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty