NPIMap

Organization Active NPI

Comfortable Care Denta Health Professionals, PA

Doing business as First Coast Smiles

  • General Practice Dentistry
  • Jacksonville, FL
National Provider Identifier
1487316568
Registry record updated Oct 6, 2021
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
First Coast Smiles
Practice address
4201 Roosevelt Blvd
Jacksonville, FL 32210-2027
Phone
(904) 388-3559
NPI assigned
Oct 6, 2021
Last updated
Oct 6, 2021By 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 Oct 6, 2021

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

4201 Roosevelt Blvd
Jacksonville, FL 32210-2027

Mailing address

4201 Roosevelt Blvd
Jacksonville, FL 32210-2027

Other names 1

  • First Coast Smiles Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Comfortable Care Dental Health Professionalspa459 organizations share this tax ID, including this one
Part of
Comfortable Care Dental Health Professionalspa

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

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": "1633478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633478400000",
    "number": "1487316568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4201 ROOSEVELT BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322102027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 ROOSEVELT BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322102027",
            "telephone_number": "904-388-3559"
        }
    ],
    "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": "2021-10-06",
        "last_updated": "2021-10-06",
        "certification_date": "2021-10-06",
        "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": "First Coast Smiles",
            "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 Oct 6, 2021; 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.