Provider Demographics
NPI:1346308608
Name:PINE GROVE DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:PINE GROVE DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:COMEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-879-1959
Mailing Address - Street 1:1475 PINE GROVE ROAD #107
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRING
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 ROAD #107
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRING
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:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty