Provider Demographics
NPI:1144628694
Name:COMFORT FAMILY DENTISTRY OF KENTWOOD
Entity type:Organization
Organization Name:COMFORT FAMILY DENTISTRY OF KENTWOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:SALAZAR
Authorized Official - Last Name:TOTH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-531-1550
Mailing Address - Street 1:937 52ND ST SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-6003
Mailing Address - Country:US
Mailing Address - Phone:616-531-1550
Mailing Address - Fax:616-531-0037
Practice Address - Street 1:937 52ND ST SE
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49508-6003
Practice Address - Country:US
Practice Address - Phone:616-531-1550
Practice Address - Fax:616-531-0037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019847122300000X
MI2901020529122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty