Provider Demographics
NPI:1104803840
Name:PINA, MERCEDES (DDS)
Entity type:Individual
Prefix:MRS
First Name:MERCEDES
Middle Name:
Last Name:PINA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 WEST 176TH STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033
Mailing Address - Country:US
Mailing Address - Phone:212-928-2900
Mailing Address - Fax:212-928-2911
Practice Address - Street 1:601 WEST 176TH STREET
Practice Address - Street 2:SUITE A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033
Practice Address - Country:US
Practice Address - Phone:212-928-2900
Practice Address - Fax:212-928-2911
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-23
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045258122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01479969Medicare ID - Type Unspecified