Provider Demographics
NPI:1962770446
Name:COMFORTDENTAL
Entity type:Organization
Organization Name:COMFORTDENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:BEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:THORNAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-947-1273
Mailing Address - Street 1:1512 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-3861
Mailing Address - Country:US
Mailing Address - Phone:970-947-1273
Mailing Address - Fax:970-928-0741
Practice Address - Street 1:1512 GRAND AVE
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-3861
Practice Address - Country:US
Practice Address - Phone:970-947-1273
Practice Address - Fax:970-928-0741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8849122300000X
CO9089122300000X
CO9296122300000X
CO10199122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty