Provider Demographics
NPI:1972717916
Name:KOMAR, FRANK GUS (DDS)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:GUS
Last Name:KOMAR
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 1:7708 LAKE SHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-3321
Mailing Address - Country:US
Mailing Address - Phone:440-257-1454
Mailing Address - Fax:440-257-1454
Practice Address - Street 1:7708 LAKE SHORE BLVD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-3321
Practice Address - Country:US
Practice Address - Phone:440-257-1454
Practice Address - Fax:440-257-1454
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH192161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice