Provider Demographics
NPI:1710754775
Name:LD-COLUMBUS, LLC
Entity Type:Organization
Organization Name:LD-COLUMBUS, LLC
Other - Org Name:BRIGHT SMILES DENTAL TWO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIZZ
Authorized Official - Middle Name:
Authorized Official - Last Name:DAIGNEAULT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-550-2310
Mailing Address - Street 1:306 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-2762
Mailing Address - Country:US
Mailing Address - Phone:662-550-2310
Mailing Address - Fax:833-740-3917
Practice Address - Street 1:323 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-1920
Practice Address - Country:US
Practice Address - Phone:662-328-3833
Practice Address - Fax:662-328-3275
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LD-COLUMBUS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-08
Last Update Date:2023-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental