Provider Demographics
NPI:1588879738
Name:KOMENDERA, JAMES C (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:C
Last Name:KOMENDERA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 S. LAPEER RD.
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-1432
Mailing Address - Country:US
Mailing Address - Phone:248-693-2194
Mailing Address - Fax:
Practice Address - Street 1:1135 S LAPEER RD
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48360-1432
Practice Address - Country:US
Practice Address - Phone:248-693-2194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI10613122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist