NPIMap

Organization Active NPI

Comfortable Care Denta Health Professionals, PA

Doing business as Pine Lake Dental Care

  • General Practice Dentistry
  • Ponte Vedra, FL
National Provider Identifier
1821809443
Registry record updated Jan 14, 2025
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
Pine Lake Dental Care
Practice address
685 Crosswater Pkwy Ste a
Ponte Vedra, FL 32081-0769
Phone
(904) 871-3008
Fax
(904) 871-3009
NPI assigned
Jan 14, 2025
Last updated
Jan 14, 2025By 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 Jan 14, 2025

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

Authorized official

Name
Juli Renee Mietzner
Title
Credentialing Manager
Phone
(217) 540-2100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

685 Crosswater Pkwy Ste a
Ponte Vedra, FL 32081-0769

Mailing address

685 Crosswater Pkwy Ste a
Ponte Vedra, FL 32081-0769
Phone (904) 871-3008

Other names 1

  • Pine Lake 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

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

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1736812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736812800000",
    "number": "1821809443",
    "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": "904-871-3008",
            "fax_number": "904-871-3009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "685 CROSSWATER PKWY STE A",
            "city": "PONTE VEDRA",
            "state": "FL",
            "postal_code": "320810769",
            "telephone_number": "904-871-3008",
            "fax_number": "904-871-3009"
        }
    ],
    "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": "2025-01-14",
        "last_updated": "2025-01-14",
        "certification_date": "2025-01-14",
        "status": "A",
        "authorized_official_last_name": "MIETZNER",
        "authorized_official_first_name": "JULI",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "217-540-2100"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pine Lake Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ponte Vedra, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2025; 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.