1972007912 NPI number — COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, P.A.

Table of content: MRS. AMY PAIGE GERALD RN (NPI 1104269133)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972007912 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:
Provider Other Organization Name Type Code:
6
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:
1972007912
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2787 SYCAMORE ST STE 106
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH PORT
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34289-9513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-423-1750
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2787 SYCAMORE ST STE 106
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH PORT
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34289-9513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-423-1750
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/23/2018

Additional Information

Authorized Official

Authorized Official Last Name:
PETERSEN
Authorized Official First Name:
CASSANDRA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING TEAM LEAD
Authorized Official Telephone Number:
217-540-8972

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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