1447461280 NPI number — THOMAS S. KELLY, DDS & RENEE COMMARATO, DDS, MS, INC.

Table of content: (NPI 1447461280)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447461280 NPI number — THOMAS S. KELLY, DDS & RENEE COMMARATO, DDS, MS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS S. KELLY, DDS & RENEE COMMARATO, DDS, MS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447461280
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1295 CORPORATE DR
Provider Second Line Business Mailing Address:
SUITE ONE
Provider Business Mailing Address City Name:
HUDSON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44236-4448
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-342-4000
Provider Business Mailing Address Fax Number:
330-342-9896

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1295 CORPORATE DR
Provider Second Line Business Practice Location Address:
SUITE ONE
Provider Business Practice Location Address City Name:
HUDSON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44236-4448
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-342-4000
Provider Business Practice Location Address Fax Number:
330-342-9896
Provider Enumeration Date:
05/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KELLY
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
330-342-4000

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  30-01-9809 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1223P0221X , with the licence number: 30-01-9108 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





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