Provider Demographics
NPI:1912093303
Name:KOMARA, STEPHEN GREGORY (DDS, PA)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:GREGORY
Last Name:KOMARA
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2260 BAYSHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-2502
Mailing Address - Country:US
Mailing Address - Phone:727-734-8891
Mailing Address - Fax:727-734-2557
Practice Address - Street 1:2260 BAYSHORE BLVD
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-2502
Practice Address - Country:US
Practice Address - Phone:727-734-8891
Practice Address - Fax:727-734-2557
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN91111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice