Provider Demographics
NPI:1699916221
Name:PINE GROVE DENTAL ARTS
Entity type:Organization
Organization Name:PINE GROVE DENTAL ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:DIEHL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-879-1959
Mailing Address - Street 1:1475 PINE GROVE RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-8803
Mailing Address - Country:US
Mailing Address - Phone:970-879-1959
Mailing Address - Fax:970-879-1973
Practice Address - Street 1:1475 PINE GROVE RD
Practice Address - Street 2:SUITE 107
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-8803
Practice Address - Country:US
Practice Address - Phone:970-879-1959
Practice Address - Fax:970-879-1973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty