Provider Demographics
NPI:1871857631
Name:PEDIATRIC DENTISTRY OF COLUMBUS
Entity Type:Organization
Organization Name:PEDIATRIC DENTISTRY OF COLUMBUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCCARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-221-2305
Mailing Address - Street 1:6801 RIVER RD
Mailing Address - Street 2:BUILDING 4, SUITE 401
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-3352
Mailing Address - Country:US
Mailing Address - Phone:706-221-2305
Mailing Address - Fax:706-221-2275
Practice Address - Street 1:6801 RIVER RD
Practice Address - Street 2:BUILDING 4, SUITE 401
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-3352
Practice Address - Country:US
Practice Address - Phone:706-221-2305
Practice Address - Fax:706-221-2275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAD0138931223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty