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General NPI Number Information
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NPI Number | 1093502312
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Entity Type | Organization
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Legal Business Name | COLUMBIA IMPLANT CENTER LLC
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Dates
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Enumeration Date | 04/21/2025
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 483 MIDDLE TPKE W STE 309
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City | MANCHESTER
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State | CT
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Zip | 06040-3865
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Country | US
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Telephone | 860-645-0111
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Fax |
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Provider Business Mailing Address
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Address Line | 483 MIDDLE TPKE W STE 309
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City | MANCHESTER
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State | CT
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Zip | 06040-3865
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Country | US
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Telephone | 860-645-0111
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ABBAS MOHAMMADI
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Credential | DDS
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Telephone | 860-985-2458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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