Provider Demographics
NPI:1962223164
Name:COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, P.A.
Entity type:Organization
Organization Name:COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:HILLARY
Authorized Official - Middle Name:
Authorized Official - Last Name:THULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-8946
Mailing Address - Street 1:4901 SEMINOLE PRATT WHITNEY RD
Mailing Address - Street 2:UNIT 1200
Mailing Address - City:LOXACHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-0018
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4901 SEMINOLE PRATT WHITNEY RD
Practice Address - Street 2:UNIT 1200
Practice Address - City:LOXACHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-0018
Practice Address - Country:US
Practice Address - Phone:561-954-5575
Practice Address - Fax:561-954-5576
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty