Provider Demographics
NPI:1629896758
Name:COLUMBIA SURGICAL PROSTHODONTICS LLC
Entity type:Organization
Organization Name:COLUMBIA SURGICAL PROSTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VENKATA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUVVA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-819-7450
Mailing Address - Street 1:19301 E US HIGHWAY 40 STE A
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-5572
Mailing Address - Country:US
Mailing Address - Phone:816-886-5899
Mailing Address - Fax:
Practice Address - Street 1:900 RAIN FOREST PKWY STE A
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-3941
Practice Address - Country:US
Practice Address - Phone:573-443-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-27
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental