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NPI Code Detail

MEDICARE: LUCY WANDA KOMOROWSKI DMD

MEDICARE: LUCY WANDA KOMOROWSKI DMD
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
1122300000XDentist6002099-15WI

General Provider Information

NPI Number : 1952656043
Entity Type Code : Individual
Provider Name (Legal Business Name) : LUCY WANDA KOMOROWSKI DMD
Provider Business Mailing Address
First Line : 1245 MAIN ST
Second Line :
City : GREEN BAY
State : WI
Zip : 54302-1306
Country : US
Telephone Number : 920-965-0831
Fax Number :
Provider Business Practice Location Address
First Line : 1245 MAIN ST
Second Line :
City : GREEN BAY
State : WI
Zip : 54302-1306
Country : US
Telephone Number : 920-965-0831
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2012
Last Update Date : 04/02/2026

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