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General NPI Number Information
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NPI Number | 1609285089
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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 | 08/11/2014
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Last Update Date | 08/11/2014
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Provider Practice Location Address
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Address Line | 149 TUSCAN WAY
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City | ST. AUGUSTINE
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State | FL
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Zip | 32092-1860
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Country | US
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Telephone | 904-201-3205
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Fax |
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Provider Business Mailing Address
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Address Line | 149 TUSCAN WAY
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City | ST. AUGUSTINE
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State | FL
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Zip | 32092-1860
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Country | US
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Telephone | 904-201-3205
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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 | ALLISON VARNER
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Credential |
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Telephone | 217-540-6077
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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 | DN19379
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License Number State | FL
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