Provider Demographics
NPI:1508396847
Name:AMERICAN PEDIATRIC DENTAL PINES LLC
Entity Type:Organization
Organization Name:AMERICAN PEDIATRIC DENTAL PINES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CORPORATE
Authorized Official - Prefix:
Authorized Official - First Name:RICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-518-5117
Mailing Address - Street 1:18501 PINES BLVD STE 211
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-1420
Mailing Address - Country:US
Mailing Address - Phone:954-417-1337
Mailing Address - Fax:954-417-1338
Practice Address - Street 1:18501 PINES BLVD STE 211
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-1420
Practice Address - Country:US
Practice Address - Phone:954-417-1337
Practice Address - Fax:954-417-1338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty