South Greeley, Prof. LLC

Primary specialty

DentistTaxonomy code 122300000X

License

9766 Issued in CO

Legal business name

SOUTH GREELEY, PROF. LLC

Doing business as

Comfort Dental South Greeley

Practice address

2716 11TH Ave
Greeley, CO 80631-8443

Phone

(970) 673-4310

NPI assigned

Feb 13, 2018

Last updated

Feb 13, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jarum Boyer, DMD

Title

Dentist/Owner

Phone

(970) 673-4310

Specialties & licenses 3

Addresses

Other identifiers 6

Other names 1

• Comfort Dental South Greeley Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1518480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1518480000000",
    "number": "1053811463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2716 11TH AVE",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806318443",
            "telephone_number": "970-673-4310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2716 11TH AVE",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806318443",
            "telephone_number": "970-673-4310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH GREELEY, PROF. LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-13",
        "last_updated": "2018-02-13",
        "status": "A",
        "authorized_official_last_name": "BOYER",
        "authorized_official_first_name": "JARUM",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "970-673-4310",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CO",
            "license": "9766",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CO",
            "license": "10437",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CO",
            "license": "10703",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1720371404",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "50472721",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1285814772",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "49305832",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "49032551",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1063555043",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Comfort Dental South Greeley",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Keila Esthefany Sotelo- Castillo
• Adrianna Gabrielle Soto-Confer
• Sierra Nickhole Soto-Martinez
• Deland Soto
• Soundview Medical Supply, LLC (Soundview Medical Supply)
• Wayne Joseph South, LPCC
• Sowash Optometry Group PC (Visionworks)
• Marci Sowko, RD, CDE
• Briana Spangler
• Dusty Speaks, LMT

• Dentist in Greeley, CO
• Providers in Greeley, CO by specialty
• Dentist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.