Provider Demographics
NPI:1508452699
Name:MCCOMB DENTAL CORP
Entity Type:Organization
Organization Name:MCCOMB DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-269-9777
Mailing Address - Street 1:920 PLEASANT GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-6139
Mailing Address - Country:US
Mailing Address - Phone:916-269-9777
Mailing Address - Fax:916-269-9777
Practice Address - Street 1:920 PLEASANT GROVE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-6184
Practice Address - Country:US
Practice Address - Phone:916-269-9777
Practice Address - Fax:916-269-9777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental