Provider Demographics
NPI:1720660004
Name:COMEAU, MACKENZIE (DDS)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:COMEAU
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1497 ABBOTT RD
Mailing Address - Street 2:
Mailing Address - City:LACKAWANNA
Mailing Address - State:NY
Mailing Address - Zip Code:14218-2057
Mailing Address - Country:US
Mailing Address - Phone:716-825-5020
Mailing Address - Fax:
Practice Address - Street 1:1497 ABBOTT RD
Practice Address - Street 2:
Practice Address - City:LACKAWANNA
Practice Address - State:NY
Practice Address - Zip Code:14218-2057
Practice Address - Country:US
Practice Address - Phone:716-825-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC126721223G0001X
NY0629731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice