Provider Demographics
NPI:1487293403
Name:COLUMBUS DENTAL CORP
Entity type:Organization
Organization Name:COLUMBUS DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANKIT
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:317-525-7398
Mailing Address - Street 1:360 E MARKET ST APT 2002
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-2961
Mailing Address - Country:US
Mailing Address - Phone:317-525-7398
Mailing Address - Fax:
Practice Address - Street 1:1641 N NATIONAL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5579
Practice Address - Country:US
Practice Address - Phone:812-799-0690
Practice Address - Fax:812-657-7877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty