MEDICARE: MT COMISKEY DDS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)

General Provider Information

NPI Number	:	1043086739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MT COMISKEY DDS PA

Provider Business Mailing Address
First Line	:	5325 VINNING ST NW STE 203
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28027-2946
Country	:	US
Telephone Number	:	704-785-8060
Fax Number	:

Provider Business Practice Location Address
First Line	:	5325 VINNING ST NW STE 203
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28027-2946
Country	:	US
Telephone Number	:	704-785-8060
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MATTHEW COMISKEY
Credential	:	DDS
Telephone Number	:	704-785-8060

Provider Enumeration Date	:	12/04/2023
Last Update Date	:	12/04/2023

Similar Medicare Providers

1750589362 — DR. MATTHEW COMISKEY DDS
Practice Location Address:

5325 VINNING ST NW STE 203
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1043773427 — DARRIEL JOSEPH CANNON DDS
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1497757983 — DR. DENISE LYNNE DEFRIES D.C.
Practice Location Address:

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1225199425 — PAUL MARK HASTIE D.C.
Practice Location Address:

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