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General NPI Number Information
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NPI Number | 1518561539
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Entity Type | Organization
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Legal Business Name | COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, P.A.
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Dates
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Enumeration Date | 11/30/2020
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Last Update Date | 01/15/2021
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Provider Practice Location Address
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Address Line | 12667 BEACH BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32246-7172
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Country | US
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Telephone | 904-204-1542
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Fax | 904-683-0359
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Provider Business Mailing Address
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Address Line | 12667 BEACH BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32246-7172
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Country | US
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Telephone | 904-208-1180
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | JESSICA BRITT
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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 | 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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