Provider Demographics
NPI:1356516389
Name:COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, PA
Entity type:Organization
Organization Name:COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HARDIEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:2900 LAKE WASHINGTON RD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-3400
Mailing Address - Country:US
Mailing Address - Phone:321-259-0217
Mailing Address - Fax:321-242-0667
Practice Address - Street 1:2900 LAKE WASHINGTON RD
Practice Address - Street 2:SUITE #3
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-3400
Practice Address - Country:US
Practice Address - Phone:321-259-0217
Practice Address - Fax:321-242-0667
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-30
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty