Provider Demographics
NPI:1497029631
Name:COLUMBIA PIKE FAMILY DENTISTRY
Entity Type:Organization
Organization Name:COLUMBIA PIKE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJEEV
Authorized Official - Middle Name:K
Authorized Official - Last Name:GOEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:513-283-4688
Mailing Address - Street 1:5900 WEST CHESTER ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069
Mailing Address - Country:US
Mailing Address - Phone:513-942-8181
Mailing Address - Fax:513-682-6188
Practice Address - Street 1:2407 COLUMBIA PIKE
Practice Address - Street 2:SUITE 208
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204
Practice Address - Country:US
Practice Address - Phone:571-312-4111
Practice Address - Fax:571-312-4133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014130781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty