Healthcare Provider Details

I. General information

NPI: 1245038579
Provider Name (Legal Business Name): COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2025
Last Update Date: 03/04/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 BLOOMINGDALE AVE
RIVERVIEW FL
33578-3717
US

IV. Provider business mailing address

1104 BLOOMINGDALE AVE
RIVERVIEW FL
33578-3717
US

V. Phone/Fax

Practice location:
  • Phone: 813-725-4347
  • Fax: 813-725-4329
Mailing address:
  • Phone: 813-725-4347
  • Fax: 813-725-4329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

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