Provider Demographics
NPI:1306952122
Name:COMFORT DENTAL STUDIO
Entity type:Organization
Organization Name:COMFORT DENTAL STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:678-377-1800
Mailing Address - Street 1:2219 LOGANVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-1622
Mailing Address - Country:US
Mailing Address - Phone:678-372-1800
Mailing Address - Fax:678-377-0740
Practice Address - Street 1:2219 LOGANVILLE HWY
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-1622
Practice Address - Country:US
Practice Address - Phone:678-372-1800
Practice Address - Fax:678-377-0740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0123361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty