Provider Demographics
NPI:1952524852
Name:COLUMBUS FAMILY DENTAL PC
Entity Type:Organization
Organization Name:COLUMBUS FAMILY DENTAL PC
Other - Org Name:MICHAEL B BURWELL DDS
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:BURWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-563-3631
Mailing Address - Street 1:2277 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601
Mailing Address - Country:US
Mailing Address - Phone:402-563-3631
Mailing Address - Fax:402-563-0520
Practice Address - Street 1:2277 22ND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601
Practice Address - Country:US
Practice Address - Phone:402-563-3631
Practice Address - Fax:402-563-0520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6067122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty