Healthcare Provider Details

I. General information

NPI: 1558283101
Provider Name (Legal Business Name): COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 DUNDEE RD
WINTER HAVEN FL
33884-0904
US

IV. Provider business mailing address

4201 DUNDEE RD
WINTER HAVEN FL
33884-0904
US

V. Phone/Fax

Practice location:
  • Phone: 863-389-1785
  • Fax: 863-389-1784
Mailing address:
  • Phone: 863-389-1785
  • Fax: 863-389-1784

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