| Columbus Children's Dentistry, Pc | |
|
4405 N Stadium Dr Suite B Columbus GA 31909-1878 | |
| (706) 225-0444 | |
| (706) 940-0008 |
| Full Name | Columbus Children's Dentistry, Pc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 4405 N Stadium Dr, Columbus, Georgia |
| Authorized Official Name and Position | Matthew Lee Keller (DENTIST/OWNER) |
| Authorized Official Contact | 7062250444 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Columbus Children's Dentistry, Pc 4405 N Stadium Dr Suite B Columbus GA 31909-1878 Ph: (706) 225-0444 | Columbus Children's Dentistry, Pc 4405 N Stadium Dr Suite B Columbus GA 31909-1878 Ph: (706) 225-0444 |
| NPI Number | 1063828499 |
|---|---|
| Provider Enumeration Date | 07/07/2014 |
| Last Update Date | 07/07/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063828499 | NPI | - | NPPES |
| 003145601A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | DN014428 (Georgia) | Primary |
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