Healthcare Provider Details

I. General information

NPI: 1922181536
Provider Name (Legal Business Name): COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11119 HEARTH RD
SPRING HILL FL
34608-3727
US

IV. Provider business mailing address

11119 HEARTH RD
SPRING HILL FL
34608-3727
US

V. Phone/Fax

Practice location:
  • Phone: 352-683-2283
  • Fax: 352-683-5504
Mailing address:
  • Phone: 352-683-2283
  • Fax: 352-683-5504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ANITA A WELLS
Title or Position: VICE PRESIDENT DENTIST
Credential: DDS
Phone: 353-683-2283