Provider Demographics
NPI:1992892582
Name:COMFORT DENTAL WEST ARVADA
Entity type:Organization
Organization Name:COMFORT DENTAL WEST ARVADA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:MAYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-421-7000
Mailing Address - Street 1:14575 WEST 64TH AVE. SUITE A
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004
Mailing Address - Country:US
Mailing Address - Phone:303-421-7000
Mailing Address - Fax:303-421-1687
Practice Address - Street 1:14575 WEST 64TH AVE. SUITE A
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004
Practice Address - Country:US
Practice Address - Phone:303-421-7000
Practice Address - Fax:303-421-1687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7897122300000X
1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO79874576Medicaid