MEDICARE: M. C. NEAGU DDS, MS, 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	302F00000X	Exclusive Provider Organization	44342	CA

General Provider Information

NPI Number	:	1811123276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M. C. NEAGU DDS, MS, INC.

Provider Business Mailing Address
First Line	:	194 S ALVARADO ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-2211
Country	:	US
Telephone Number	:	213-927-2030
Fax Number	:	213-413-8246

Provider Business Practice Location Address
First Line	:	194 S ALVARADO ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-2211
Country	:	US
Telephone Number	:	213-927-2030
Fax Number	:	213-413-8246

Authorized Official
Title or Position	:	OWNER/ DOCTOR
Name	:	CAMILLE NEAGU
Credential	:	DDS, MS
Telephone Number	:	213-927-2030

Provider Enumeration Date	:	05/29/2009
Last Update Date	:	05/29/2009

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