NPIMap

Organization Active NPI

Comfortable Care Dental Health Professionals, PA

Doing business as Smiles at Julington Creek

  • General Practice Dentistry
  • Saint Johns, FL
National Provider Identifier
1043760390
Registry record updated Dec 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, PA
Doing business as
Smiles at Julington Creek
Practice address
2532 Race Track Rd
Saint Johns, FL 32259
Phone
(904) 342-8423
Fax
(904) 679-3226
NPI assigned
Oct 11, 2016
Last updated
Dec 19, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 19, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kendra Walker
Title
Credentialing Team Lead
Phone
(217) 540-8312

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

2532 Race Track Rd
Saint Johns, FL 32259

Mailing address

2532 Race Track Rd
Suite B
Saint Johns, FL 32259
Phone (904) 342-8423

Other names 1

  • Smiles at Julington Creek Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Comfortable Care Dental Health Professionals PA457 organizations share this tax ID, including this one
Part of
Comfortable Care Dental Health Professionals PA

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

2532 Race Track Rd
Saint Johns, FL 32259
Phone (904) 342-8423

2532 Race Track Rd
Ste B
St Johns, FL 32259
Phone (904) 342-8423

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1476144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482105600000",
    "number": "1043760390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2532 RACE TRACK RD",
            "address_2": "SUITE B",
            "city": "SAINT JOHNS",
            "state": "FL",
            "postal_code": "32259",
            "telephone_number": "904-342-8423",
            "fax_number": "904-679-3226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2532 RACE TRACK RD",
            "city": "SAINT JOHNS",
            "state": "FL",
            "postal_code": "32259",
            "telephone_number": "904-342-8423",
            "fax_number": "904-679-3226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, PA",
        "enumeration_date": "2016-10-11",
        "last_updated": "2016-12-19",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "KENDRA",
        "authorized_official_title_or_position": "CREDENTIALING TEAM LEAD",
        "authorized_official_telephone_number": "217-540-8312"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Smiles at Julington Creek",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Johns, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.