Provider Demographics
NPI:1023186087
Name:OREST G KOMARNYCKYJ DDS PC
Entity Type:Organization
Organization Name:OREST G KOMARNYCKYJ DDS PC
Other - Org Name:FIRST STEP DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:OREST
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:KOMARNYCKYJ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-266-3430
Mailing Address - Street 1:1277 E MISSOURI AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2915
Mailing Address - Country:US
Mailing Address - Phone:602-266-3430
Mailing Address - Fax:
Practice Address - Street 1:1277 E MISSOURI AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2915
Practice Address - Country:US
Practice Address - Phone:602-266-3430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD27071223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty