Healthcare Provider Details

I. General information

NPI: 1952511719
Provider Name (Legal Business Name): RENEE COMMARATO,DDS,MS,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 06/11/2009
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
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: DR. RENEE COMMARATO
Title or Position: PRESIDENT
Credential: DDS, MS
Phone: 330-394-1516