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Organization
COLUMBUS ADVANCED FAMILY DENTISTRY
Active
Organization
COLUMBUS ADVANCED FAMILY DENTISTRY
Active
Parent organization
COLUMBUS PEDIATRIC DENTISTRY
Organization subpart
Yes
Provider details
NPI number
Legal business name
COLUMBUS PEDIATRIC DENTISTRY
Authorized official
PROF. MARVIN PAVLOV J.D., M.S., M.B.A (CEO)
(812) 603-3996
Entity
Organization
Contact information
Practice address
3158 N NATIONAL RD, COLUMBUS, IN 47201-3170
(812) 603-3996
(812) 376-0459
Mailing address
3158 N NATIONAL RD, COLUMBUS, IN 47201-3170
(812) 603-3996
(812) 376-0459
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
13003577A
IN
Other
Enumeration date
07/19/2013
Last updated
07/19/2013
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