Bruce Eliot Komarow, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

6508 Issued in CT

Practice address

40 Dale Road
Avon, CT 06001

Phone

(860) 677-2171

Fax

(860) 677-2427

NPI assigned

May 4, 2007

Sex

Male

Sole proprietor

Yes

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

Enrolled in CT

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1932311453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 DALE ROAD",
            "city": "AVON",
            "state": "CT",
            "postal_code": "06001",
            "telephone_number": "860-677-2171",
            "fax_number": "860-677-2427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 DALE ROAD",
            "city": "AVON",
            "state": "CT",
            "postal_code": "06001",
            "telephone_number": "860-677-2171",
            "fax_number": "860-677-2427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOMAROW",
        "first_name": "BRUCE",
        "middle_name": "ELIOT",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CT",
            "license": "6508",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peter John Knowles, D.M.D.
• Debra J Knox, LMFT
• Meredith Kocot, PA-C
• Bartlomiej Kolcz, DPT
• Komarow Dental PC
• Vamsi Koneru, PH.D.
• Koster Family Chiropractic LLC
• Michael J Koster, D.C.
• Nicolette Kathleen Kovacs, M.A., CCC-SLP
• Nicole Kowalski

• Dentist in Avon, CT
• Providers in Avon, CT by specialty
• Dentist in Connecticut

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.