Healthcare Provider Details

I. General information

NPI: 1932733896
Provider Name (Legal Business Name): COLUMBIA CENTER FOR IMPLANTS & PERIODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2020
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6395 DOBBIN RD STE 208
COLUMBIA MD
21045-4759
US

IV. Provider business mailing address

6395 DOBBIN RD STE 208
COLUMBIA MD
21045-4759
US

V. Phone/Fax

Practice location:
  • Phone: 410-997-1189
  • Fax: 410-992-5474
Mailing address:
  • Phone: 410-997-1189
  • Fax: 410-992-5474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: CARRIE SLAPPO
Title or Position: INSURANCE COORDINATOR
Credential:
Phone: 410-997-1189