Provider Demographics
NPI:1184958225
Name:GREATER COLUMBUS PERIODONTICS, LLC, RYAN J. SERRA, DMD, MS
Entity type:Organization
Organization Name:GREATER COLUMBUS PERIODONTICS, LLC, RYAN J. SERRA, DMD, MS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SERRA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:614-451-1122
Mailing Address - Street 1:1914 BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-1802
Mailing Address - Country:US
Mailing Address - Phone:614-451-1122
Mailing Address - Fax:
Practice Address - Street 1:1914 BETHEL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-1802
Practice Address - Country:US
Practice Address - Phone:614-451-1122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0146661223P0300X
OH0230931223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty