Healthcare Provider Details

I. General information

NPI: 1972408128
Provider Name (Legal Business Name): COMEAU FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 REVOLUTION ST
HAVRE DE GRACE MD
21078-3322
US

IV. Provider business mailing address

736 REVOLUTION ST
HAVRE DE GRACE MD
21078-3322
US

V. Phone/Fax

Practice location:
  • Phone: 410-939-3890
  • Fax:
Mailing address:
  • Phone: 410-939-3890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. KIMBERLEY COMEAU
Title or Position: OWNER
Credential:
Phone: 410-939-3890