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	:	1851503577
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, PA

Provider Business Mailing Address
First Line	:	2127 W STATE ROAD 434
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32779-4983
Country	:	US
Telephone Number	:	407-332-6060
Fax Number	:	407-332-8190

Provider Business Practice Location Address
First Line	:	2127 W STATE ROAD 434
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32779-4983
Country	:	US
Telephone Number	:	407-332-6060
Fax Number	:	407-332-8190

Authorized Official
Title or Position	:	INS COOD
Name	:	ALL CREDENTIALING
Credential	:
Telephone Number	:	217-540-2100

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	10/19/2022

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