Individual
STEPHEN KOMYATI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
133 BROOKLINE AVE, BOSTON, MA 02215-3904
(617) 421-1122
Mailing address
147 MILK ST, PROVIDER ENROLLMENT 9TH FLOOR, BOSTON, MA 02109-4806
(617) 559-8051
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
18568
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PD197
HARVARD PILGRIM
MA
01
—
X08000
BCBS - DENTAL
MA
Enumeration date
04/06/2006
Last updated
04/07/2009
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