Active NPI
Dominic Comerate
- Advanced Practice Dental Therapist
- Fairbanks, AK
National Provider Identifier
1760969422
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Advanced Practice Dental Therapist
- License
- 18-147-DHAT
- Practice address
- 1717 W Cowles St
Fairbanks, AK 99701-5926 - Phone
- (907) 452-8251
- NPI assigned
- Jul 25, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | |||
| Advanced Practice Dental Therapist | 125K00000X | 18-147-DHAT | AK | Primary |
Addresses
Primary practice location
1717 W Cowles St
Fairbanks, AK 99701-5926
Mailing address
1717 W Cowles St
Fairbanks, AK 99701-5926
Phone (907) 452-8251
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18-147-DHAT | AK | MD | Advanced Practice Dental Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1532476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1662508800000",
"number": "1760969422",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1717 W COWLES ST",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997015926",
"telephone_number": "907-452-8251"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1717 W COWLES ST",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997015926",
"telephone_number": "907-452-8251"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COMERATE",
"first_name": "DOMINIC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-07-25",
"last_updated": "2022-09-07",
"certification_date": "2022-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": null,
"license": null,
"primary": false
},
{
"code": "125K00000X",
"taxonomy_group": "",
"desc": "Advanced Practice Dental Therapist",
"state": "AK",
"license": "18-147-DHAT",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairbanks, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.