Provider Demographics
NPI:1093069080
Name:COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS
Entity Type:Organization
Organization Name:COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS
Other - Org Name:SUMTER DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUERTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-2100
Mailing Address - Street 1:1585 GRAND VENTURE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34286-2310
Mailing Address - Country:US
Mailing Address - Phone:941-876-4023
Mailing Address - Fax:941-876-4369
Practice Address - Street 1:1585 GRAND VENTURE DR
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34286-2310
Practice Address - Country:US
Practice Address - Phone:941-876-4023
Practice Address - Fax:941-876-4369
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-30
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty