Provider Demographics
NPI:1730296435
Name:PHILIP A. PINE DDS PA.
Entity Type:Organization
Organization Name:PHILIP A. PINE DDS PA.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:PINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-782-1992
Mailing Address - Street 1:1600 E ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-6768
Mailing Address - Country:US
Mailing Address - Phone:954-782-1992
Mailing Address - Fax:
Practice Address - Street 1:1600 E ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-6768
Practice Address - Country:US
Practice Address - Phone:954-782-1992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty