1497029631 NPI number — COLUMBIA PIKE FAMILY DENTISTRY

Table of content: (NPI 1497029631)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497029631 NPI number — COLUMBIA PIKE FAMILY DENTISTRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLUMBIA PIKE FAMILY DENTISTRY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497029631
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5900 WEST CHESTER ROAD
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
WEST CHESTER
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-942-8181
Provider Business Mailing Address Fax Number:
513-682-6188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2407 COLUMBIA PIKE
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
571-312-4111
Provider Business Practice Location Address Fax Number:
571-312-4133
Provider Enumeration Date:
03/06/2012

Additional Information

Authorized Official

Authorized Official Last Name:
GOEL
Authorized Official First Name:
SANJEEV
Authorized Official Middle Name:
K.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
513-283-4688

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  0401413078 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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