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NPI Code Detail

MEDICARE: COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, P.A.

MEDICARE: COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, P.A.
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 : 1619560489
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, P.A.
Provider Business Mailing Address
First Line : 175 MARINER BLVD
Second Line :
City : SPRING HILL
State : FL
Zip : 34609-5625
Country : US
Telephone Number : 352-403-1309
Fax Number :
Provider Business Practice Location Address
First Line : 175 MARINER BLVD
Second Line :
City : SPRING HILL
State : FL
Zip : 34609-5625
Country : US
Telephone Number : 352-403-1309
Fax Number :
Authorized Official
Title or Position : CREDENTIALING COORDINATOR
Name : CELIA HAYES
Credential :
Telephone Number : 217-540-2100
Provider Enumeration Date : 02/12/2021
Last Update Date : 02/12/2021

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