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General NPI Number Information
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NPI Number | 1932990157
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Entity Type | Organization
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Legal Business Name | COLUMBUS PEDIATRIC DENTISTRY, LLC
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Dates
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Enumeration Date | 05/15/2025
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 3005 19TH ST STE 700
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City | COLUMBUS
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State | NE
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Zip | 68601-4248
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Country | US
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Telephone | 402-585-0001
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Fax | 402-585-0504
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Provider Business Mailing Address
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Address Line | 8374 HILLSIDE PLZ
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City | COLUMBUS
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State | NE
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Zip | 68601-7327
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Country | US
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Telephone | 308-520-9765
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Fax |
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Authorized Official
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Title or Position | DDS
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Name | KAITLYNN L HARVEY
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Credential |
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Telephone | 308-520-9765
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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