Healthcare Provider Details

I. General information

NPI: 1801692942
Provider Name (Legal Business Name): COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 02/20/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17021 THREE OAKS MARKETPLACE DR UNIT 101
FORT MYERS FL
33912-2587
US

IV. Provider business mailing address

17021 THREE OAKS MARKETPLACE DR UNIT 101
FORT MYERS FL
33912-2587
US

V. Phone/Fax

Practice location:
  • Phone: 239-955-8101
  • Fax: 239-955-8102
Mailing address:
  • Phone: 239-955-8101
  • Fax:

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: CEMYIRA MCDOUGAL
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 217-764-8609