MEDICARE: COLUMBIA PIKE FAMILY DENTISTRY

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	1223G0001X	General Practice Dentistry	0401413078	VA

General Provider Information

NPI Number	:	1497029631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBIA PIKE FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	5900 WEST CHESTER ROAD
Second Line	:	SUITE A
City	:	WEST CHESTER
State	:	OH
Zip	:	45069
Country	:	US
Telephone Number	:	513-942-8181
Fax Number	:	513-682-6188

Provider Business Practice Location Address
First Line	:	2407 COLUMBIA PIKE
Second Line	:	SUITE 208
City	:	ARLINGTON
State	:	VA
Zip	:	22204
Country	:	US
Telephone Number	:	571-312-4111
Fax Number	:	571-312-4133

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SANJEEV K. GOEL
Credential	:	DDS
Telephone Number	:	513-283-4688

Provider Enumeration Date	:	03/06/2012
Last Update Date	:	03/06/2012

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