Active NPI
Kimberley Comeau, DDS
- Dentist
- Baltimore, MD
National Provider Identifier
1487179529
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 16377
- Practice address
- 650 W Baltimore St
Baltimore, MD 21201-1510 - Phone
- (410) 706-7101
- NPI assigned
- Aug 10, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 16377 | MD | Primary |
Addresses
Primary practice location
650 W Baltimore St
Baltimore, MD 21201-1510
Mailing address
650 W Baltimore St
Baltimore, MD 21201-1510
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171128002176 | MD | Order and Referring Only - Dentist | 2769749886 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16377 | MD | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1502323200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1502323200000",
"number": "1487179529",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "650 W BALTIMORE ST",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212011510"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "650 W BALTIMORE ST",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212011510",
"telephone_number": "410-706-7101"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COMEAU",
"first_name": "KIMBERLEY",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-08-10",
"last_updated": "2017-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MD",
"license": "16377",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.