MEDICARE: COLUMBIA 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	9089	TN

General Provider Information

NPI Number	:	1972997906
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBIA FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	1300 HATCHER LN STE 6
Second Line	:
City	:	COLUMBIA
State	:	TN
Zip	:	38401-3554
Country	:	US
Telephone Number	:	931-840-8890
Fax Number	:	931-840-8885

Provider Business Practice Location Address
First Line	:	1300 HATCHER LN STE 6
Second Line	:
City	:	COLUMBIA
State	:	TN
Zip	:	38401-3554
Country	:	US
Telephone Number	:	931-840-8890
Fax Number	:	931-840-8885

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. LAUREN WILBURN
Credential	:	D.D.S
Telephone Number	:	931-840-8890

Provider Enumeration Date	:	03/27/2015
Last Update Date	:	03/27/2015

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