Provider Demographics
NPI:1992596811
Name:PINES DENTAL PA
Entity type:Organization
Organization Name:PINES DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:OLMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-951-0335
Mailing Address - Street 1:7744 PETERS RD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-4004
Mailing Address - Country:US
Mailing Address - Phone:954-905-6633
Mailing Address - Fax:954-302-6898
Practice Address - Street 1:7744 PETERS RD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-4004
Practice Address - Country:US
Practice Address - Phone:954-905-6633
Practice Address - Fax:954-302-6898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty