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General NPI Number Information
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NPI Number | 1144534843
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Entity Type | Organization
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Legal Business Name | COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, PA
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Dates
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Enumeration Date | 08/05/2010
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Last Update Date | 08/05/2010
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Provider Practice Location Address
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Address Line | 7521 W SAND LAKE RD
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City | ORLANDO
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State | FL
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Zip | 32819-5109
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Country | US
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Telephone | 407-354-0044
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Fax | 407-354-0003
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Provider Business Mailing Address
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Address Line | 7521 W SAND LAKE RD
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City | ORLANDO
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State | FL
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Zip | 32819-5109
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Country | US
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Telephone | 407-354-0044
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Fax | 407-354-0003
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Authorized Official
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Title or Position | INSURANCE / CREDENTIALING
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Name | PAM HARDIEK
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Credential |
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Telephone | 217-540-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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