Provider Demographics
NPI:1770132581
Name:AUBURN PERIODONTICS OF COLUMBUS, LLC
Entity type:Organization
Organization Name:AUBURN PERIODONTICS OF COLUMBUS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRITANY
Authorized Official - Middle Name:FABIAN
Authorized Official - Last Name:MATIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:334-444-0571
Mailing Address - Street 1:400 BROOKSTONE CENTRE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-3640
Mailing Address - Country:US
Mailing Address - Phone:706-222-7149
Mailing Address - Fax:
Practice Address - Street 1:400 BROOKSTONE CENTRE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-3640
Practice Address - Country:US
Practice Address - Phone:706-222-7149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty