Provider Demographics
NPI:1487819140
Name:COLUMBIA FAMILY DENTAL CENTER
Entity Type:Organization
Organization Name:COLUMBIA FAMILY DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DUPREE
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-791-4398
Mailing Address - Street 1:2315 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-4715
Mailing Address - Country:US
Mailing Address - Phone:803-791-4398
Mailing Address - Fax:
Practice Address - Street 1:2315 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4715
Practice Address - Country:US
Practice Address - Phone:803-791-4398
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty