MEDICARE: COLUMBIA DENTAL SERVICES

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	050260	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	16356	OTHER	NY	DORAL

General Provider Information

NPI Number	:	1598915027
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBIA DENTAL SERVICES

Provider Business Mailing Address
First Line	:	563 W 169TH ST
Second Line	:	SUITE NUMBER 100
City	:	NEW YORK
State	:	NY
Zip	:	10032-3912
Country	:	US
Telephone Number	:	212-923-3375
Fax Number	:	646-253-1270

Provider Business Practice Location Address
First Line	:	563 W 169TH ST
Second Line	:	SUITE NUMBER 100
City	:	NEW YORK
State	:	NY
Zip	:	10032-3912
Country	:	US
Telephone Number	:	212-923-3375
Fax Number	:	646-253-1270

Authorized Official
Title or Position	:	CEO
Name	:	DR. FALGUNI PATEL
Credential	:	D.D.S
Telephone Number	:	212-923-3375

Provider Enumeration Date	:	09/20/2008
Last Update Date	:	09/20/2008

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Directions to “COLUMBIA DENTAL SERVICES ” Practice Location

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