Columbia Dental Management, Inc.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

12597 Issued in MA

Legal business name

COLUMBIA DENTAL MANAGEMENT, INC.

Practice address

653 Columbia Rd
Dorchester, MA 02125

Phone

(617) 825-9100

Fax

(617) 506-1141

NPI assigned

Nov 18, 2011

Last updated

Feb 4, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. William M Adams

Title

President

Phone

(617) 825-9100

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Columbia & Broadway, Orthodontics, Inc. Former legal business name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1321574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454544000000",
    "number": "1366719395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "653 COLUMBIA RD",
            "city": "DORCHESTER",
            "state": "MA",
            "postal_code": "02125",
            "telephone_number": "617-825-9100",
            "fax_number": "617-506-1141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "653 COLUMBIA RD",
            "city": "DORCHESTER",
            "state": "MA",
            "postal_code": "02125",
            "telephone_number": "617-825-9100",
            "fax_number": "617-506-1141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUMBIA DENTAL MANAGEMENT, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-18",
        "last_updated": "2016-02-04",
        "status": "A",
        "authorized_official_last_name": "ADAMS",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "617-825-9100",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "MA",
            "license": "12597",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9903954",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Columbia & Broadway, Orthodontics, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Stephanie Elizabeth Coleman
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• Meredith Coley, RD
• Cynthia Regina Collins
• Columbia Family Dental
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• Community Care Pharmacy, Inc (Community Care Pharmacy)

• Orthodontics and Dentofacial Orthopedics Dentistry in Dorchester, MA
• Providers in Dorchester, MA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.