Provider Demographics
NPI:1336540038
Name:COMFORT DENTAL VAIL VALLEY
Entity type:Organization
Organization Name:COMFORT DENTAL VAIL VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WILFORD
Authorized Official - Last Name:LINDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-949-7911
Mailing Address - Street 1:PO BOX 4537
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CO
Mailing Address - Zip Code:81620-4537
Mailing Address - Country:US
Mailing Address - Phone:970-949-7911
Mailing Address - Fax:970-949-1593
Practice Address - Street 1:0101 FAWCETT RD
Practice Address - Street 2:SUITE 170
Practice Address - City:AVON
Practice Address - State:CO
Practice Address - Zip Code:81620
Practice Address - Country:US
Practice Address - Phone:970-949-7911
Practice Address - Fax:970-949-1593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-12
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO40353346Medicaid