Provider Demographics
NPI:1780858928
Name:COLUMBUS FAMILY DENTISTRY INC.
Entity Type:Organization
Organization Name:COLUMBUS FAMILY DENTISTRY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:NEGRELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-342-0766
Mailing Address - Street 1:4020 W GOELLER BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-8273
Mailing Address - Country:US
Mailing Address - Phone:812-342-0766
Mailing Address - Fax:812-342-2427
Practice Address - Street 1:4020 W GOELLER BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-8273
Practice Address - Country:US
Practice Address - Phone:812-342-0766
Practice Address - Fax:812-342-2427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009878A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty