Provider Demographics
NPI:1508605528
Name:COMPREHENSIVE FAMILY DENTISTRY
Entity type:Organization
Organization Name:COMPREHENSIVE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COLIN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:GUSTUS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:623-247-0041
Mailing Address - Street 1:1646 N LITCHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-1203
Mailing Address - Country:US
Mailing Address - Phone:623-247-0041
Mailing Address - Fax:623-247-0459
Practice Address - Street 1:1646 N LITCHFIELD RD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-1203
Practice Address - Country:US
Practice Address - Phone:623-247-0041
Practice Address - Fax:623-247-0459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental