# COLUMBIA IMPLANT CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093502312
- **Authorized official:** ABBAS MOHAMMADI DDS (OWNER)
- **Authorized official phone:** (860) 985-2458

## Contact information

- **Practice address:** 483 MIDDLE TPKE W STE 309, MANCHESTER, CT 06040-3865
- **Practice address phone:** (860) 645-0111
- **Mailing address:** 483 MIDDLE TPKE W STE 309, MANCHESTER, CT 06040-3865
- **Mailing address phone:** (860) 645-0111

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | — | NULL | — |
| 1223E0200X | Endodontics | — | — | — |
| 1223P0221X | Pediatric Dentistry | — | NULL | — |
| 1223P0221X | Pediatric Dentistry | — | — | — |
| 1223P0300X | Periodontics | — | NULL | — |
| 1223P0300X | Periodontics | — | — | — |
| 1223P0700X | Prosthodontics | — | NULL | — |
| 1223P0700X | Prosthodontics | — | — | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | — | NULL | — |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | — | — | — |

## Other

- **Enumeration date:** 04/21/2025
- **Last updated:** 04/21/2025