Provider Demographics
NPI:1386085520
Name:COMPREHENSIVE AESTHETIC DENTAL ASSOCIATES LLC
Entity type:Organization
Organization Name:COMPREHENSIVE AESTHETIC DENTAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ROBY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-641-0954
Mailing Address - Street 1:1055 17TH AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-2680
Mailing Address - Country:US
Mailing Address - Phone:303-776-1335
Mailing Address - Fax:303-776-7516
Practice Address - Street 1:1055 17TH AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-2680
Practice Address - Country:US
Practice Address - Phone:303-776-1335
Practice Address - Fax:303-776-7516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-16
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1041631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty