Provider Demographics
NPI:1750105227
Name:CAPITOL SQUARE DENTAL OF COLUMBUS
Entity type:Organization
Organization Name:CAPITOL SQUARE DENTAL OF COLUMBUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MEHRDAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SAFAVIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-789-9000
Mailing Address - Street 1:6748 BALLANTRAE PL
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-6024
Mailing Address - Country:US
Mailing Address - Phone:614-461-4600
Mailing Address - Fax:614-789-9012
Practice Address - Street 1:212 S HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4502
Practice Address - Country:US
Practice Address - Phone:614-461-4600
Practice Address - Fax:614-789-9012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty