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General NPI Number Information
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NPI Number | 1205697380
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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 | 01/17/2024
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Last Update Date | 01/17/2024
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Provider Practice Location Address
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Address Line | 49545 HIGHWAY 27
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City | DAVENPORT
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State | FL
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Zip | 33897-9507
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Country | US
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Telephone | 863-758-2992
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Fax | 853-758-2994
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Provider Business Mailing Address
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Address Line | 49545 HIGHWAY 27
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City | DAVENPORT
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State | FL
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Zip | 33897-9507
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Country | US
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Telephone | 863-758-2992
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Fax | 853-758-2994
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Authorized Official
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Title or Position | CREDENTIALING
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Name | CEMYIRA MCDOUGAL
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Credential |
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Telephone | 217-764-8609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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