NPIMap

Organization Active NPI

Comfortable Care Dental Health Professionals, PA

Doing business as Mill Creek Dental Care

  • Dentist
  • St Augustine, FL
National Provider Identifier
1609285089
Registry record updated Aug 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN19379 Issued in FL
Legal business name
COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, PA
Doing business as
Mill Creek Dental Care
Practice address
149 Tuscan Way
St. Augustine, FL 32092-1860
Phone
(904) 201-3205
NPI assigned
Aug 11, 2014
Last updated
Aug 11, 2014By 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 Aug 11, 2014

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

Authorized official

Name
Allison Varner
Title
Credentialing Coordinator
Phone
(217) 540-6077

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X DN19379 FL Primary

Addresses

Primary practice location

149 Tuscan Way
St. Augustine, FL 32092-1860

Mailing address

149 Tuscan Way
St. Augustine, FL 32092-1860
Phone (904) 201-3205

Other names 1

  • Mill Creek Dental Care 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

Locations

149 Tuscan Way
St Augustine, FL 32092
Phone (904) 201-3205

Practitioners & affiliated clinicians

Practitioners 1

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": "1407715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407715200000",
    "number": "1609285089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "149 TUSCAN WAY",
            "city": "ST. AUGUSTINE",
            "state": "FL",
            "postal_code": "320921860",
            "telephone_number": "904-201-3205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "149 TUSCAN WAY",
            "city": "ST. AUGUSTINE",
            "state": "FL",
            "postal_code": "320921860",
            "telephone_number": "904-201-3205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, PA",
        "enumeration_date": "2014-08-11",
        "last_updated": "2014-08-11",
        "status": "A",
        "authorized_official_last_name": "VARNER",
        "authorized_official_first_name": "ALLISON",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-6077"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN19379",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mill Creek Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Augustine, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2014; 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.