Provider Demographics
NPI:1407078918
Name:COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, PA
Entity Type:Organization
Organization Name:COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, PA
Other - Org Name:BAYMEADOWS JUNCTION DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INS COORD
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KROEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:8206 PHILIPS HWY
Mailing Address - Street 2:SUITE 21
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-1220
Mailing Address - Country:US
Mailing Address - Phone:904-448-6122
Mailing Address - Fax:904-448-6108
Practice Address - Street 1:8206 PHILIPS HWY
Practice Address - Street 2:SUITE 21
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-1220
Practice Address - Country:US
Practice Address - Phone:904-448-6122
Practice Address - Fax:904-448-6108
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-03
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty