Provider Demographics
NPI:1962718213
Name:LAURA COMEAU DDS PC
Entity type:Organization
Organization Name:LAURA COMEAU DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:COMEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-921-4847
Mailing Address - Street 1:2100 CALLE DE LA VUELTA UNIT E105
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4819
Mailing Address - Country:US
Mailing Address - Phone:505-570-9578
Mailing Address - Fax:
Practice Address - Street 1:2100 CALLE DE LA VUELTA UNIT E105
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4819
Practice Address - Country:US
Practice Address - Phone:505-570-9578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD27971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM9184626OtherDORAL
NM77532Medicaid