Provider Demographics
NPI:1407011984
Name:COMFORT DENTAL THORNTON GROUP
Entity type:Organization
Organization Name:COMFORT DENTAL THORNTON GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.D.S
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROMELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-429-2273
Mailing Address - Street 1:9203 HURON ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80260-5495
Mailing Address - Country:US
Mailing Address - Phone:303-429-2273
Mailing Address - Fax:303-429-3233
Practice Address - Street 1:9203 HURON ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80260-5495
Practice Address - Country:US
Practice Address - Phone:303-429-2273
Practice Address - Fax:303-429-3233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO21901341Medicaid