Provider Demographics
NPI:1437290897
Name:KOMOC, BASHAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:BASHAR
Middle Name:
Last Name:KOMOC
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 1:3318E 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 1:7151 W 91ST ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3446
Practice Address - Country:US
Practice Address - Phone:310-670-2983
Practice Address - Fax:310-670-2983
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA423171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice