NPIMap

Organization Active NPI

Comfortable Care Denta Health Professionals, PA

Doing business as Lakeside Dental Care

  • General Practice Dentistry
  • Jacksonville, FL
National Provider Identifier
1144816497
Registry record updated Dec 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
COMFORTABLE CARE DENTA HEALTH PROFESSIONALS, PA
Doing business as
Lakeside Dental Care
Practice address
2511 Saint Johns Bluff Rd S Ste 206
Jacksonville, FL 32246-2345
Phone
(904) 329-3371
NPI assigned
Dec 21, 2020
Last updated
Dec 21, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
COMFORTABLE CARE DENTA HEALTH PROFESSIONALS, PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 21, 2020

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

Authorized official

Name
Tabatha Lemke
Title
Credentialing Coordinator
Phone
(217) 540-6078

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

2511 Saint Johns Bluff Rd S Ste 206
Jacksonville, FL 32246-2345

Mailing address

2511 Saint Johns Bluff Rd S Ste 206
Jacksonville, FL 32246-2345

Other names 1

  • Lakeside Dental Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Comfortable Care Dental Health Professionals457 organizations share this tax ID, including this one
Part of
Comfortable Care Dental Health Professionals

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

2511 Saint Johns Bluff Rd S
Ste 206
Jacksonville, FL 32246
Phone (904) 329-3371

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

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": "1608508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608508800000",
    "number": "1144816497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2511 SAINT JOHNS BLUFF RD S STE 206",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322462345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2511 SAINT JOHNS BLUFF RD S STE 206",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322462345",
            "telephone_number": "904-329-3371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMFORTABLE CARE DENTA HEALTH PROFESSIONALS, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMFORTABLE CARE DENTA HEALTH PROFESSIONALS, PA",
        "enumeration_date": "2020-12-21",
        "last_updated": "2020-12-21",
        "certification_date": "2020-12-21",
        "status": "A",
        "authorized_official_last_name": "LEMKE",
        "authorized_official_first_name": "TABATHA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-6078"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeside Dental Care",
            "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 Dec 21, 2020; 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.