Provider Demographics
NPI:1366756348
Name:COMFORT, RYAN T
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:T
Last Name:COMFORT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-3670
Mailing Address - Country:US
Mailing Address - Phone:607-797-5932
Mailing Address - Fax:607-797-4150
Practice Address - Street 1:501 PLAZA DR
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-3670
Practice Address - Country:US
Practice Address - Phone:607-797-5932
Practice Address - Fax:607-797-4150
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0550461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice