Healthcare Provider Details

I. General information

NPI: 1669300703
Provider Name (Legal Business Name): COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 JACARANDA BLVD
VENICE FL
34292-4570
US

IV. Provider business mailing address

1150 JACARANDA BLVD
VENICE FL
34292-4570
US

V. Phone/Fax

Practice location:
  • Phone: 941-477-2683
  • Fax:
Mailing address:
  • Phone: 941-477-2683
  • Fax:

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
Credential:
Phone: 217-764-8609