Provider Demographics
NPI:1356781504
Name:COMM, SIDNEY TODD (DDS)
Entity type:Individual
Prefix:
First Name:SIDNEY
Middle Name:TODD
Last Name:COMM
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 1:1300 N LINCOLN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:DIXON
Mailing Address - State:CA
Mailing Address - Zip Code:95620-2022
Mailing Address - Country:US
Mailing Address - Phone:707-678-9296
Mailing Address - Fax:707-678-9307
Practice Address - Street 1:1300 N LINCOLN ST
Practice Address - Street 2:SUITE A
Practice Address - City:DIXON
Practice Address - State:CA
Practice Address - Zip Code:95620-2022
Practice Address - Country:US
Practice Address - Phone:707-678-9296
Practice Address - Fax:707-678-9307
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA269751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice