Healthcare Provider Details

I. General information

NPI: 1750589362
Provider Name (Legal Business Name): MATTHEW COMISKEY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5325 VINNING ST NW STE 203
CONCORD NC
28027-2946
US

IV. Provider business mailing address

5325 VINNING ST NW STE 203
CONCORD NC
28027-2946
US

V. Phone/Fax

Practice location:
  • Phone: 704-785-8060
  • Fax:
Mailing address:
  • Phone: 704-785-8060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number3566
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number8538
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: