Provider Demographics
NPI:1730338369
Name:COLUMBIA UNIV DENTAL SCHOOL
Entity type:Organization
Organization Name:COLUMBIA UNIV DENTAL SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DEAN FOR CLINICAL AFFAIRS
Authorized Official - Prefix:DR
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-305-5686
Mailing Address - Street 1:630 W 168TH ST
Mailing Address - Street 2:P&S BOX 30
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3725
Mailing Address - Country:US
Mailing Address - Phone:212-305-5686
Mailing Address - Fax:
Practice Address - Street 1:622 W 168TH ST
Practice Address - Street 2:VANDERBILT CLINIC 9TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3720
Practice Address - Country:US
Practice Address - Phone:212-305-5686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00302034Medicaid