Provider Demographics
NPI:1396135810
Name:MISSIH, COMLAN MARCEL (DDS)
Entity type:Individual
Prefix:MR
First Name:COMLAN
Middle Name:MARCEL
Last Name:MISSIH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:COMLAN
Other - Middle Name:
Other - Last Name:MISSIHOUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:770 JAMES STREET, SUITE 214
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203
Mailing Address - Country:US
Mailing Address - Phone:315-475-1533
Mailing Address - Fax:315-475-1548
Practice Address - Street 1:770 JAMES STREET, SUITE 214
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203
Practice Address - Country:US
Practice Address - Phone:315-475-1533
Practice Address - Fax:315-475-1548
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-04
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT011324122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist