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Organization
COLUMBIA DENTAL SPECIALTY GROUP
Active
Organization
COLUMBIA DENTAL SPECIALTY GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JENNIFER CHANG D.D.S. (PRESIDENT/OWNER)
(310) 264-1711
Entity
Organization
Contact information
Practice address
1807 WILSHIRE BLVD, STE A, SANTA MONICA, CA 90403-5652
(310) 264-1711
(310) 453-6486
Mailing address
1807 WILSHIRE BLVD, STE A, SANTA MONICA, CA 90403-5652
(310) 264-1711
(310) 453-6486
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
59653
CA
1223P0300X
Periodontics
Primary
53057
CA
Other
Enumeration date
08/18/2014
Last updated
08/18/2014
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