Provider Demographics
NPI:1720133499
Name:COMFORT DENTAL GROUP OF NORTHGLENN
Entity type:Organization
Organization Name:COMFORT DENTAL GROUP OF NORTHGLENN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-452-6630
Mailing Address - Street 1:10780 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80233-3439
Mailing Address - Country:US
Mailing Address - Phone:303-452-6630
Mailing Address - Fax:303-252-0237
Practice Address - Street 1:10780 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80233-3439
Practice Address - Country:US
Practice Address - Phone:303-452-6630
Practice Address - Fax:303-252-0237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1041821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty