Provider Demographics
NPI:1124278247
Name:CHARLES P. COLUMPAR, JR., DMD, INC.
Entity type:Organization
Organization Name:CHARLES P. COLUMPAR, JR., DMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:LABORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:401-846-6265
Mailing Address - Street 1:477 E MAIN RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-5202
Mailing Address - Country:US
Mailing Address - Phone:401-846-6265
Mailing Address - Fax:401-846-1648
Practice Address - Street 1:477 E MAIN RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-5202
Practice Address - Country:US
Practice Address - Phone:401-846-6265
Practice Address - Fax:401-846-1648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI1600122300000X
RI1518122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty