MEDICARE: COLUMBUS CENTER FOR PERIODONTICS AND DENTAL IMPLANTS

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1346973997
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBUS CENTER FOR PERIODONTICS AND DENTAL IMPLANTS

Provider Business Mailing Address
First Line	:	3180 MIDDLE RD
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47203-2298
Country	:	US
Telephone Number	:	812-372-2141
Fax Number	:

Provider Business Practice Location Address
First Line	:	3180 MIDDLE RD
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47203-2298
Country	:	US
Telephone Number	:	812-372-2141
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GREGORY PHILLIPS
Credential	:	DDS, MSD
Telephone Number	:	812-372-2141

Provider Enumeration Date	:	07/01/2022
Last Update Date	:	07/01/2022

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