Provider Demographics
NPI:1346647781
Name:FLORIDAN DENTAL AT PINES, PLLC
Entity Type:Organization
Organization Name:FLORIDAN DENTAL AT PINES, PLLC
Other - Org Name:FLORIDIAN DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:VINUELA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-441-8778
Mailing Address - Street 1:12251 TAFT ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-1901
Mailing Address - Country:US
Mailing Address - Phone:954-441-8778
Mailing Address - Fax:
Practice Address - Street 1:12251 TAFT ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-1901
Practice Address - Country:US
Practice Address - Phone:954-441-8778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN192531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty