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General NPI Number Information
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NPI Number | 1609349877
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Entity Type | Organization
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Legal Business Name | COMFY SMILE DENTAL
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Dates
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Enumeration Date | 01/09/2019
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Last Update Date | 01/09/2019
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Provider Practice Location Address
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Address Line | 11356 W STATE ROAD 84
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City | DAVIE
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State | FL
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Zip | 33325-4007
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Country | US
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Telephone | 954-251-0804
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Fax |
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Provider Business Mailing Address
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Address Line | 1508 WHITEHALL DR APT 303
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City | DAVIE
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State | FL
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Zip | 33324-6617
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Country | US
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Telephone | 954-243-5286
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | GUILLERMO CORTES MORALES
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Credential | DMD
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Telephone | 954-243-5286
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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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