| Columbia Dental Group | |
|
515 Columbia Drive Johnson City NY 13790 | |
| (607) 770-1122 | |
| (607) 770-1176 |
| Full Name | Columbia Dental Group |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 515 Columbia Drive, Johnson City, New York |
| Authorized Official Name and Position | Roger Antonio Conti (PARTNER) |
| Authorized Official Contact | 6077701122 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Columbia Dental Group 515 Columbia Drive Johnson City NY 13790 Ph: (607) 770-1122 | Columbia Dental Group 515 Columbia Drive Johnson City NY 13790 Ph: (607) 770-1122 |
| NPI Number | 1891825600 |
|---|---|
| Provider Enumeration Date | 03/07/2007 |
| Last Update Date | 04/30/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891825600 | NPI | - | NPPES |
| 104448556 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 041409 (New York) | Primary |
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