Provider Demographics
NPI:1598943870
Name:PINE ISLAND DENTAL INC
Entity Type:Organization
Organization Name:PINE ISLAND DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZURFLUH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-476-1163
Mailing Address - Street 1:8850 W STATE ROAD 84
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-4455
Mailing Address - Country:US
Mailing Address - Phone:954-476-1163
Mailing Address - Fax:954-476-0015
Practice Address - Street 1:8850 W STATE ROAD 84
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-4455
Practice Address - Country:US
Practice Address - Phone:954-476-1163
Practice Address - Fax:954-476-0015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0013443122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty