Healthcare Provider Details

I. General information

NPI: 1528988292
Provider Name (Legal Business Name): COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 N SUNCOAST BLVD
CRYSTAL RIVER FL
34429-5442
US

IV. Provider business mailing address

180 N SUNCOAST BLVD
CRYSTAL RIVER FL
34429-5442
US

V. Phone/Fax

Practice location:
  • Phone: 352-436-6180
  • Fax: 352-436-6191
Mailing address:
  • Phone: 352-436-6180
  • Fax: 352-436-6191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: HILLARY THULL
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 217-540-8946