NPIMap

Organization Active NPI

Comfortable Care Dental Health Professionals, P.a.

Doing business as Crosswater Dental Care

  • General Practice Dentistry
  • Ponte Vedra Beach, FL
National Provider Identifier
1366988743
Registry record updated Dec 27, 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.
Doing business as
Crosswater Dental Care
Practice address
210 Marketside Ave Ste 1
Ponte Vedra Beach, FL 32081-1195
Phone
(904) 686-1400
Fax
(904) 834-7608
NPI assigned
Jan 10, 2017
Last updated
Dec 27, 2024By 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 27, 2024

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

210 Marketside Ave Ste 1
Ponte Vedra Beach, FL 32081-1195

Mailing address

685 Crosswater Pkwy Ste a
Ponte Vedra, FL 32081-0769
Phone (904) 686-1400

Other names 1

  • Crosswater Dental Care 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

210 Marketside Ave
Ste 1
Ponte Vedra Beach, FL 32081
Phone (904) 686-1400

685 Crosswater Pkwy
Ste A
Ponte Vedra Beach, FL 32081
Phone (904) 686-1400

Practitioners & affiliated clinicians

Practitioners 4

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": "1484006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735257600000",
    "number": "1366988743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "685 CROSSWATER PKWY STE A",
            "city": "PONTE VEDRA",
            "state": "FL",
            "postal_code": "320810769",
            "telephone_number": "904-686-1400",
            "fax_number": "904-834-7608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 MARKETSIDE AVE STE 1",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320811195",
            "telephone_number": "904-686-1400",
            "fax_number": "904-834-7608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, P.A.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, PA",
        "enumeration_date": "2017-01-10",
        "last_updated": "2024-12-27",
        "certification_date": "2024-12-27",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "KENDRA",
        "authorized_official_title_or_position": "CREDENTIALING SUPERVISOR",
        "authorized_official_telephone_number": "217-540-8312"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crosswater Dental Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Crosswater Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ponte Vedra Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 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.