Provider Demographics
NPI:1689811085
Name:COLUMBIA FAMILY DENTAL
Entity Type:Organization
Organization Name:COLUMBIA FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANHPHI
Authorized Official - Middle Name:THI
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-825-9100
Mailing Address - Street 1:653 COLUMBIA RD
Mailing Address - Street 2:FL.1
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02125-1712
Mailing Address - Country:US
Mailing Address - Phone:617-825-9100
Mailing Address - Fax:617-825-5006
Practice Address - Street 1:653 COLUMBIA RD
Practice Address - Street 2:FL.1
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02125-1712
Practice Address - Country:US
Practice Address - Phone:617-825-9100
Practice Address - Fax:617-825-5006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21968302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization