MEDICARE: COLUMBUS ENDODONTICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics

General Provider Information

NPI Number	:	1417824582
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBUS ENDODONTICS LLC

Provider Business Mailing Address
First Line	:	8318 LIGHTFOOT CT
Second Line	:
City	:	AUBURN
State	:	AL
Zip	:	36830-8520
Country	:	US
Telephone Number	:	334-444-0571
Fax Number	:

Provider Business Practice Location Address
First Line	:	7310 N LAKE DR STE C
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-1697
Country	:	US
Telephone Number	:	706-222-7799
Fax Number	:

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	DR. BRITANY FABIAN MATIN
Credential	:	DMD
Telephone Number	:	334-444-0571

Provider Enumeration Date	:	10/22/2025
Last Update Date	:	10/22/2025

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