Provider Demographics
NPI:1447461280
Name:THOMAS S. KELLY, DDS & RENEE COMMARATO, DDS, MS, INC.
Entity type:Organization
Organization Name:THOMAS S. KELLY, DDS & RENEE COMMARATO, DDS, MS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-342-4000
Mailing Address - Street 1:1295 CORPORATE DR
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-4448
Mailing Address - Country:US
Mailing Address - Phone:330-342-4000
Mailing Address - Fax:330-342-9896
Practice Address - Street 1:1295 CORPORATE DR
Practice Address - Street 2:SUITE ONE
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-4448
Practice Address - Country:US
Practice Address - Phone:330-342-4000
Practice Address - Fax:330-342-9896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-01-98091223G0001X
OH30-01-91081223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty