Provider Demographics
NPI:1043086739
Name:MT COMISKEY DDS PA
Entity Type:Organization
Organization Name:MT COMISKEY DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:COMISKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-785-8060
Mailing Address - Street 1:5325 VINNING ST NW STE 203
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-2946
Mailing Address - Country:US
Mailing Address - Phone:704-785-8060
Mailing Address - Fax:
Practice Address - Street 1:5325 VINNING ST NW STE 203
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-2946
Practice Address - Country:US
Practice Address - Phone:704-785-8060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty