Provider Demographics
NPI:1891128468
Name:COLUMBIA CITY DENTAL
Entity Type:Organization
Organization Name:COLUMBIA CITY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:ZOE
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-790-0678
Mailing Address - Street 1:3810 S FERDINAND ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-1750
Mailing Address - Country:US
Mailing Address - Phone:206-743-8356
Mailing Address - Fax:206-829-8961
Practice Address - Street 1:3810 S FERDINAND ST STE 201
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-1750
Practice Address - Country:US
Practice Address - Phone:206-743-8356
Practice Address - Fax:206-829-8961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-18
Last Update Date:2013-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE601028821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty