Columbia Dental Specialty Group

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

53057 Issued in CA

Legal business name

COLUMBIA DENTAL SPECIALTY GROUP

Practice address

1807 Wilshire Blvd
Ste a
Santa Monica, CA 90403-5652

Phone

(310) 264-1711

Fax

(310) 453-6486

NPI assigned

Aug 18, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Jennifer Chang, D.D.S.

Title

President/Owner

Phone

(310) 264-1711

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1408320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1408320000000",
    "number": "1851790661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1807 WILSHIRE BLVD",
            "address_2": "STE A",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904035652",
            "telephone_number": "310-264-1711",
            "fax_number": "310-453-6486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1807 WILSHIRE BLVD",
            "address_2": "STE A",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904035652",
            "telephone_number": "310-264-1711",
            "fax_number": "310-453-6486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUMBIA DENTAL SPECIALTY GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-18",
        "last_updated": "2014-08-18",
        "status": "A",
        "authorized_official_last_name": "CHANG",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "310-264-1711",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": "CA",
            "license": "59653",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "53057",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Francesca Colla, LPCC
• Machaela Collins, FNP
• Whitney Kay Collinsworth
• Gregory J Colman, MD
• Columbia Dental Group
• Allegra Comas
• Eden Juliet Comess-Daniels, MSW CANDIDATE
• Communicology, Inc.
• Eyson Concepcion, N.P.
• Corinne April Iolanda Conn, MD

• Periodontics in Santa Monica, CA
• Providers in Santa Monica, CA by specialty
• Periodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2014; 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.