Healthcare Provider Details

I. General information

NPI: 1134339997
Provider Name (Legal Business Name): RENEE COMMARATO DDS,MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 06/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8845 E MARKET ST SUITE 2
WARREN OH
44484-2377
US

IV. Provider business mailing address

8845 E MARKET ST SUITE 2
WARREN OH
44484-2377
US

V. Phone/Fax

Practice location:
  • Phone: 330-394-1516
  • Fax: 330-394-1517
Mailing address:
  • Phone: 330-394-1516
  • Fax: 330-394-1517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number30-01-9108
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: