Provider Demographics
NPI:1699930107
Name:COLLEGE OF DENTISTRY
Entity type:Organization
Organization Name:COLLEGE OF DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TEACHING INTERN
Authorized Official - Prefix:DR
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:FURCHTGOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-440-9980
Mailing Address - Street 1:2966 NEIL AVE APT 201A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-2027
Mailing Address - Country:US
Mailing Address - Phone:614-440-9980
Mailing Address - Fax:
Practice Address - Street 1:305 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1267
Practice Address - Country:US
Practice Address - Phone:614-292-2212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty