Provider Demographics
NPI:1336372382
Name:PINES DENTAL CARE, INC
Entity type:Organization
Organization Name:PINES DENTAL CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ROXANA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-450-9383
Mailing Address - Street 1:302 NW 179TH AVE
Mailing Address - Street 2:SUITE 201 A
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2818
Mailing Address - Country:US
Mailing Address - Phone:954-450-9383
Mailing Address - Fax:954-450-9385
Practice Address - Street 1:302 NW 179TH AVE
Practice Address - Street 2:SUITE 201 A
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2818
Practice Address - Country:US
Practice Address - Phone:954-450-9383
Practice Address - Fax:954-450-9385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty