Healthcare Provider Details

I. General information

NPI: 1568383024
Provider Name (Legal Business Name): JORDAN MALIK COMAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 KINKAID RD
ANNAPOLIS MD
21402-1006
US

IV. Provider business mailing address

110 STONE POINT DR UNIT 126
ANNAPOLIS MD
21401-6994
US

V. Phone/Fax

Practice location:
  • Phone: 410-293-2273
  • Fax:
Mailing address:
  • Phone: 631-645-8215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number9389
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: