| Komarow Dental Pc | |
|
40 Dale Rd Avon CT 06001-3692 | |
| (860) 677-2171 | |
| (860) 677-2171 |
| Full Name | Komarow Dental Pc |
|---|---|
| Speciality | Clinic/center |
| Location | 40 Dale Rd, Avon, Connecticut |
| Authorized Official Name and Position | Bruce E Komarow (OWNER) |
| Authorized Official Contact | 8606772171 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Komarow Dental Pc 40 Dale Rd Avon CT 06001-3692 Ph: (860) 677-2171 | Komarow Dental Pc 40 Dale Rd Avon CT 06001-3692 Ph: (860) 677-2171 |
| NPI Number | 1851807218 |
|---|---|
| Provider Enumeration Date | 12/21/2017 |
| Last Update Date | 12/21/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851807218 | NPI | - | NPPES |
| 1932311453 | Other | CT | IRS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 6508 (Connecticut) | Primary |
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