Provider Demographics
NPI:1811123276
Name:M. C. NEAGU DDS, MS, INC.
Entity type:Organization
Organization Name:M. C. NEAGU DDS, MS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEAGU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:213-927-2030
Mailing Address - Street 1:194 S ALVARADO ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2211
Mailing Address - Country:US
Mailing Address - Phone:213-927-2030
Mailing Address - Fax:213-413-8246
Practice Address - Street 1:194 S ALVARADO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2211
Practice Address - Country:US
Practice Address - Phone:213-927-2030
Practice Address - Fax:213-413-8246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44342302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization