# STATE AVENUE DENTAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Comfort Dental - State Avenue
- **Organization subpart:** No

## Provider details

- **NPI number:** 1881959278
- **Authorized official:** DR. MATTHEW FOGG TINGEY DDS (DENTIST)
- **Authorized official phone:** (913) 213-6973

## Contact information

- **Practice address:** 7933 STATE AVE, SUITE 101, KANSAS CITY, KS 66112-2468
- **Practice address phone:** (913) 213-6973
- **Practice address fax:** (913) 213-6972
- **Mailing address:** 7933 STATE AVE, SUITE 101, KANSAS CITY, KS 66112-2468
- **Mailing address phone:** (913) 213-6973
- **Mailing address fax:** (913) 213-6972

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 60853 | KS | Yes |

## Other

- **Enumeration date:** 07/11/2012
- **Last updated:** 07/11/2012