Provider Demographics
NPI:1942823182
Name:KOMAN, DANIEL GREGORY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:GREGORY
Last Name:KOMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34225 N 27TH DRIVE
Mailing Address - Street 2:BLDG 5 ST 241
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-6091
Mailing Address - Country:US
Mailing Address - Phone:623-439-2280
Mailing Address - Fax:626-289-2578
Practice Address - Street 1:3668 WEST ANTHEM WAY
Practice Address - Street 2:#162
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086
Practice Address - Country:US
Practice Address - Phone:623-551-7500
Practice Address - Fax:623-551-5175
Is Sole Proprietor?:No
Enumeration Date:2020-05-22
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.026113122300000X
AZD0111111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist