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NPI Code Detail

MEDICARE: COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, PA

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
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1407078918
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, PA
Provider Business Mailing Address
First Line : 8206 PHILIPS HWY
Second Line : SUITE 21
City : JACKSONVILLE
State : FL
Zip : 32256-1220
Country : US
Telephone Number : 904-448-6122
Fax Number : 904-448-6108
Provider Business Practice Location Address
First Line : 8206 PHILIPS HWY
Second Line : SUITE 21
City : JACKSONVILLE
State : FL
Zip : 32256-1220
Country : US
Telephone Number : 904-448-6122
Fax Number : 904-448-6108
Authorized Official
Title or Position : INS COORD
Name : AMY KROEGER
Credential :
Telephone Number : 217-540-5100
Provider Enumeration Date : 05/03/2007
Last Update Date : 04/02/2008

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Directions to “COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, PA ” Practice Location

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