Provider Demographics
NPI:1114181260
Name:BASHAR KOMOC DDS, INC.
Entity Type:Organization
Organization Name:BASHAR KOMOC DDS, INC.
Other - Org Name:AMERICAN DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BASHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KOMOC
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-986-5570
Mailing Address - Street 1:3318 E ANAHEIM ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-4025
Mailing Address - Country:US
Mailing Address - Phone:562-986-5570
Mailing Address - Fax:562-986-9791
Practice Address - Street 1:3318 E ANAHEIM ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-4025
Practice Address - Country:US
Practice Address - Phone:562-986-5570
Practice Address - Fax:562-986-9791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA423171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty