NPIMap

Organization Active NPI

Comfortable Care Denta Health Professionals, PA

  • 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
Practice address
4201 Roosevelt Blvd
Jacksonville, FL 32210-2027
Phone
(904) 388-3559
NPI assigned
Oct 6, 2021
Organization subpart
Yes
Parent organization
COMFORTABLE CARE DENTA HEALTH PROFESSIONALS, PAAs reported in NPPES

Authorized official

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

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.

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

National Provider Directory
Tax ID family
Comfortable Care Denta Health Professionals PA (455 organizations share this tax ID)
Part of
Comfortable Care Denta Health Professionals PA

Locations

4201 Roosevelt Blvd
Jacksonville, FL 32210
Phone (904) 388-3559

Specialties & licenses 1

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

Addresses

NPPES NPI Registry

Primary practice location

4201 Roosevelt Blvd
Jacksonville, FL 32210-2027

Mailing address

4201 Roosevelt Blvd
Jacksonville, FL 32210-2027

Other names 1

NPPES NPI Registry
  • First Coast Smiles Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 6, 2021.

{
    "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.