Provider Demographics
NPI:1871501049
Name:COMER, KATIE RUTH (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:RUTH
Last Name:COMER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:NE
Mailing Address - Zip Code:68467-3040
Mailing Address - Country:US
Mailing Address - Phone:402-362-4636
Mailing Address - Fax:402-362-6098
Practice Address - Street 1:223 E 8TH ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:NE
Practice Address - Zip Code:68467-3040
Practice Address - Country:US
Practice Address - Phone:402-362-4636
Practice Address - Fax:402-362-6098
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE62551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47-071566612Medicaid