MEDICARE: COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, P.A.

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	:	1770068199
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, P.A.

Provider Business Mailing Address
First Line	:	5845 WINTER GARDEN VINELAND RD STE 110
Second Line	:
City	:	WINDERMERE
State	:	FL
Zip	:	34786-6124
Country	:	US
Telephone Number	:	321-319-8689
Fax Number	:

Provider Business Practice Location Address
First Line	:	5845 WINTER GARDEN VINELAND RD STE 110
Second Line	:
City	:	WINDERMERE
State	:	FL
Zip	:	34786-6124
Country	:	US
Telephone Number	:	321-319-8689
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	JESSICA BRITT
Credential	:
Telephone Number	:	217-540-8426

Provider Enumeration Date	:	10/02/2018
Last Update Date	:	10/02/2018

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