Provider Demographics
NPI:1518000892
Name:COLUMBIA DENTAL CARE LTD
Entity Type:Organization
Organization Name:COLUMBIA DENTAL CARE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRADFORD
Authorized Official - Last Name:RODENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-281-7137
Mailing Address - Street 1:106 EDELWEISS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236-2508
Mailing Address - Country:US
Mailing Address - Phone:618-281-7137
Mailing Address - Fax:618-281-7140
Practice Address - Street 1:106 EDELWEISS DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:IL
Practice Address - Zip Code:62236-2508
Practice Address - Country:US
Practice Address - Phone:618-281-7137
Practice Address - Fax:618-281-7140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty