1588781314 NPI number — COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588781314 NPI number — COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CORAL RIDGE DENTAL ARTS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588781314
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1831 NE 45TH ST
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
FORT LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33308-5117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-771-3331
Provider Business Mailing Address Fax Number:
954-771-7795

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1831 NE 45TH ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
FORT LAUDERDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33308-5117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-771-3331
Provider Business Practice Location Address Fax Number:
954-771-7795
Provider Enumeration Date:
03/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PRUEMER
Authorized Official First Name:
HEATHER
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING SUPERVISOR
Authorized Official Telephone Number:
217-540-8434

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DN0011299 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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