MEDICARE: COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN19236	FL

General Provider Information

NPI Number	:	1154750180
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, PA

Provider Business Mailing Address
First Line	:	2970 WEST US HWY 90
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-4730
Country	:	US
Telephone Number	:	386-243-2028
Fax Number	:

Provider Business Practice Location Address
First Line	:	2970 WEST US HWY 90
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-4730
Country	:	US
Telephone Number	:	386-243-2028
Fax Number	:

Authorized Official
Title or Position	:	INSURANCE CREDENTIALING
Name	:	ALLISON VARNER
Credential	:
Telephone Number	:	217-540-6077

Provider Enumeration Date	:	11/12/2013
Last Update Date	:	11/12/2013

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