Provider Demographics
NPI:1871714741
Name:KOMARNYCKYJ, OREST G (DDS)
Entity type:Individual
Prefix:
First Name:OREST
Middle Name:G
Last Name:KOMARNYCKYJ
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 1:1277 E MISSOURI AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2915
Mailing Address - Country:US
Mailing Address - Phone:602-266-3430
Mailing Address - Fax:602-266-7519
Practice Address - Street 1:1277 E MISSOURI AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2915
Practice Address - Country:US
Practice Address - Phone:602-266-3430
Practice Address - Fax:602-266-7519
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD27071223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics