Healthcare Provider Details

I. General information

NPI: 1346103934
Provider Name (Legal Business Name): COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 W IRLO BRONSON MEMORIAL HWY
KISSIMMEE FL
34747-1002
US

IV. Provider business mailing address

9040 W IRLO BRONSON MEMORIAL HWY
KISSIMMEE FL
34747-1002
US

V. Phone/Fax

Practice location:
  • Phone: 689-212-0050
  • Fax: 689-212-0027
Mailing address:
  • Phone: 689-212-0050
  • Fax: 689-212-0027

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