MEDICARE: COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS,PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1518290196
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS,PA

Provider Business Mailing Address
First Line	:	5963 SE FEDERAL HWY
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34997-7871
Country	:	US
Telephone Number	:	772-283-5360
Fax Number	:

Provider Business Practice Location Address
First Line	:	5963 SE FEDERAL HWY
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34997-7871
Country	:	US
Telephone Number	:	772-283-5360
Fax Number	:

Authorized Official
Title or Position	:	INSURANCE/CREDENTIALING
Name	:	KAM SHICK
Credential	:
Telephone Number	:	217-540-5100

Provider Enumeration Date	:	09/14/2009
Last Update Date	:	09/14/2009

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