Provider Demographics
NPI:1740225317
Name:ABBAS MOHAMMADI, D.D.S., P.C.
Entity Type:Organization
Organization Name:ABBAS MOHAMMADI, D.D.S., P.C.
Other - Org Name:COLUMBIA DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ABBAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMMADI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PC
Authorized Official - Phone:860-645-0111
Mailing Address - Street 1:483 W MIDDLE TPKE
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-3863
Mailing Address - Country:US
Mailing Address - Phone:860-645-0111
Mailing Address - Fax:860-533-9027
Practice Address - Street 1:483 W MIDDLE TPKE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-3863
Practice Address - Country:US
Practice Address - Phone:860-645-0111
Practice Address - Fax:860-533-9027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0085141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty