NPIMap

Organization Active NPI

Comfortable Care Dental Health Professionals. P.a.

  • General Practice Dentistry
  • Jacksonville, FL
National Provider Identifier
1114755485
Registry record updated Jul 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS. P.A.
Practice address
11919 Atlantic Blvd Unit 101
Jacksonville, FL 32225-2971
Phone
(904) 204-9918
Fax
(904) 204-9149
NPI assigned
Jul 26, 2024
Organization subpart
Yes
Parent organization
COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, P.A.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 26, 2024

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

Authorized official

Name
Hillary Thull
Title
Credentialing Coordinator
Phone
(217) 540-8946

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

11919 Atlantic Blvd Unit 101
Jacksonville, FL 32225-2971

Mailing address

11919 Atlantic Blvd Unit 101
Jacksonville, FL 32225-2971

Other names 1

  • Shore Haven Dentistry Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Comfortable Care Denta Health Professionals PA455 organizations share this tax ID, including this one
Part of
Comfortable Care Denta 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

11919 Atlantic Blvd
Unit 101
Jacksonville, FL 32225
Phone (904) 204-9918

NPI Registry JSON

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

{
    "created_epoch": "1721952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721952000000",
    "number": "1114755485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11919 ATLANTIC BLVD UNIT 101",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322252971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11919 ATLANTIC BLVD UNIT 101",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322252971",
            "telephone_number": "904-204-9918",
            "fax_number": "904-204-9149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS. P.A.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, P.A.",
        "enumeration_date": "2024-07-26",
        "last_updated": "2024-07-26",
        "certification_date": "2024-07-26",
        "status": "A",
        "authorized_official_last_name": "THULL",
        "authorized_official_first_name": "HILLARY",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-8946"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shore Haven Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2024; 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.