MEDICARE: ALLAN G. COMIA D.D.S. INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	51248	CA

General Provider Information

NPI Number	:	1013426691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLAN G. COMIA D.D.S. INC

Provider Business Mailing Address
First Line	:	303 GLENDALE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-5036
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 GLENDALE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-5036
Country	:	US
Telephone Number	:	213-484-2850
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALLAN COMIA
Credential	:
Telephone Number	:	213-484-2850

Provider Enumeration Date	:	09/26/2017
Last Update Date	:	09/26/2017

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