Healthcare Provider Details

I. General information

NPI: 1649185505
Provider Name (Legal Business Name): COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 NE JENSEN BEACH BLVD LOWR
JENSEN BEACH FL
34957-7296
US

IV. Provider business mailing address

1930 NE JENSEN BEACH BLVD LOWR
JENSEN BEACH FL
34957-7296
US

V. Phone/Fax

Practice location:
  • Phone: 772-334-6090
  • Fax:
Mailing address:
  • Phone: 772-334-6090
  • 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: HILLARY THULL
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 217-540-8946