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General NPI Number Information
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NPI Number | 1952635930
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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 | 09/24/2009
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Last Update Date | 08/04/2023
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Provider Practice Location Address
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Address Line | 1250 TAMIAMI TRL N S107
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City | NAPLES
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State | FL
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Zip | 34102-5248
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Country | US
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Telephone | 239-263-4445
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Fax | 239-263-1558
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Provider Business Mailing Address
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Address Line | 1250 TAMIAMI TRL N S107
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City | NAPLES
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State | FL
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Zip | 34102-5248
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Country | US
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Telephone | 239-263-4445
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Fax | 239-263-1558
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Authorized Official
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Title or Position | CREDENTIALING TEAM LEAD
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Name | CASSANDRA PETERSEN
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Credential |
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Telephone | 217-540-8972
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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 | FL8320/FL9455
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License Number State |
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