Organization
COLUMBIA DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JENNIFER W CHANG DDS (VICE PRESIDENT)
(310) 453-5436
Entity
Organization
Contact information
Practice address
1807 WILSHIRE BLVD, SUITE A, SANTA MONICA, CA 90403-5652
(310) 453-5436
Mailing address
1807 WILSHIRE BLVD, SUITE A, SANTA MONICA, CA 90403-5652
(310) 453-5436
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
55347
CA
122300000X
Dentist
Primary
55758
CA
Other
Enumeration date
09/30/2013
Last updated
09/30/2013
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