| Columbia Dental Center Llc | |
|
915 N Main St St #2 Columbia IL 62236-1157 | |
| (618) 281-6161 | |
| Not Available |
| Full Name | Columbia Dental Center Llc |
|---|---|
| Speciality | Durable Medical Equipment & Medical Supplies - Customized Equipment |
| Location | 915 N Main St, Columbia, Illinois |
| Authorized Official Name and Position | Rick Leppo (OWNER) |
| Authorized Official Contact | 6182816161 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Columbia Dental Center Llc 915 N Main St St #2 Columbia IL 62236-1157 Ph: (618) 281-6161 | Columbia Dental Center Llc 915 N Main St St #2 Columbia IL 62236-1157 Ph: (618) 281-6161 |
| NPI Number | 1356897433 |
|---|---|
| Provider Enumeration Date | 08/29/2016 |
| Last Update Date | 08/29/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356897433 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 019027680 (Illinois) | Secondary |
| 332BC3200X | Durable Medical Equipment & Medical Supplies - Customized Equipment | 019027680 (Illinois) | Primary |
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