Provider Demographics
NPI:1316455017
Name:PINO PERIODONTICS, LLC
Entity type:Organization
Organization Name:PINO PERIODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-822-0565
Mailing Address - Street 1:PO BOX 94598
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87199-4598
Mailing Address - Country:US
Mailing Address - Phone:505-822-0565
Mailing Address - Fax:505-821-4242
Practice Address - Street 1:7007 WYOMING BLVD NE STE D1
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3981
Practice Address - Country:US
Practice Address - Phone:505-822-0565
Practice Address - Fax:505-821-4242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty