Provider Demographics
NPI:1306062112
Name:COMFORT DENTAL WESTMINSTER
Entity type:Organization
Organization Name:COMFORT DENTAL WESTMINSTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:
Authorized Official - Last Name:HIGGINBOTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-427-2722
Mailing Address - Street 1:10350 NORTH FEDERAL BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80260
Mailing Address - Country:US
Mailing Address - Phone:303-427-2722
Mailing Address - Fax:303-427-9280
Practice Address - Street 1:10350 NORTH FEDERAL BLVD
Practice Address - Street 2:STE 300
Practice Address - City:FEDERAL HEIGHTS
Practice Address - State:CO
Practice Address - Zip Code:80260
Practice Address - Country:US
Practice Address - Phone:303-427-2722
Practice Address - Fax:303-427-9280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9964122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04010443Medicaid