Gary Komenaka, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

54488 Issued in CA

Practice address

249 N McDowell Blvd
Petaluma, CA 94954-2306

Phone

(707) 765-9262

NPI assigned

Jul 28, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 18, 2017 through Apr 18, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• William Cox Dental Corporation

  dba Gentle Dental Petaluma

  • Dentist
  • Petaluma, CA
  • NPI 1467496893
  NPD (past)
• Ala Moana Dental Care, Inc.

  • General Practice Dentistry
  • Honolulu, HI
  • NPI 1851663033
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1649284118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 W BENJAMIN HOLT DR",
            "address_2": "BUILDING B",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952073839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "249 N MCDOWELL BLVD",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949542306",
            "telephone_number": "707-765-9262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOMENAKA",
        "first_name": "GARY",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "54488",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Koda Physical Therapy and Sports Performance
• Tamara Koelling
• Robert David Koenitzer, DDS
• Susan Marie Kokke, LMFT 40557
• Judith Komatsu, N.P, L.A.C.
• Richard Korman, DDS
• Anthony P. Kosinski, M.D.
• Pavel Kostyshak, DC
• Jeffrey Kou
• Dorothy Joo Kowal, LMFT

• General Practice Dentistry in Petaluma, CA
• Providers in Petaluma, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.