Provider Demographics
NPI:1699040246
Name:COLUMBIA DENTISTRY, LLC
Entity Type:Organization
Organization Name:COLUMBIA DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHAMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:BEY EL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-798-6333
Mailing Address - Street 1:1727 BROAD RIVER ROAD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-7332
Mailing Address - Country:US
Mailing Address - Phone:803-798-6333
Mailing Address - Fax:
Practice Address - Street 1:421 BUSH RIVER RD #5
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210
Practice Address - Country:US
Practice Address - Phone:803-445-3906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-15
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30-03757122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty