Provider Demographics
NPI:1326189770
Name:COLUMBIA DENTAL CARE
Entity Type:Organization
Organization Name:COLUMBIA DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:KLEITCHES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-738-2424
Mailing Address - Street 1:PO BOX 6723
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29260-6723
Mailing Address - Country:US
Mailing Address - Phone:803-738-2424
Mailing Address - Fax:803-738-0277
Practice Address - Street 1:4702 FOREST DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29206-3109
Practice Address - Country:US
Practice Address - Phone:803-738-2424
Practice Address - Fax:803-738-0277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ32224Medicaid