Healthcare Provider Details

I. General information

NPI: 1497029631
Provider Name (Legal Business Name): COLUMBIA PIKE FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2012
Last Update Date: 03/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2407 COLUMBIA PIKE SUITE 208
ARLINGTON VA
22204
US

IV. Provider business mailing address

5900 WEST CHESTER ROAD SUITE A
WEST CHESTER OH
45069
US

V. Phone/Fax

Practice location:
  • Phone: 571-312-4111
  • Fax: 571-312-4133
Mailing address:
  • Phone: 513-942-8181
  • Fax: 513-682-6188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401413078
License Number StateVA

VIII. Authorized Official

Name: DR. SANJEEV K. GOEL
Title or Position: OWNER
Credential: DDS
Phone: 513-283-4688