Provider Demographics
NPI:1356897433
Name:COLUMBIA DENTAL CENTER LLC
Entity type:Organization
Organization Name:COLUMBIA DENTAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:LEPPO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:618-281-6161
Mailing Address - Street 1:915 N MAIN ST
Mailing Address - Street 2:ST #2
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236-1157
Mailing Address - Country:US
Mailing Address - Phone:618-281-6161
Mailing Address - Fax:
Practice Address - Street 1:915 N MAIN ST
Practice Address - Street 2:ST #2
Practice Address - City:COLUMBIA
Practice Address - State:IL
Practice Address - Zip Code:62236-1157
Practice Address - Country:US
Practice Address - Phone:618-281-6161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027680122300000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No122300000XDental ProvidersDentistGroup - Multi-Specialty