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	:	1952810061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, P.A.

Provider Business Mailing Address
First Line	:	6 E BAY ST STE 101
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32202-5416
Country	:	US
Telephone Number	:	904-356-0072
Fax Number	:	904-356-2338

Provider Business Practice Location Address
First Line	:	6 E BAY ST STE 101
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32202-5416
Country	:	US
Telephone Number	:	904-356-0072
Fax Number	:	904-356-2338

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	HILLARY THULL
Credential	:
Telephone Number	:	217-540-8946

Provider Enumeration Date	:	09/21/2017
Last Update Date	:	02/02/2024

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