Provider Demographics
NPI:1841427259
Name:PINELAND DENTAL PC
Entity Type:Organization
Organization Name:PINELAND DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-681-9200
Mailing Address - Street 1:8520 SPRUCE MOUNTAIN ROAD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LARKSPUR
Mailing Address - State:CO
Mailing Address - Zip Code:80118
Mailing Address - Country:US
Mailing Address - Phone:303-681-9200
Mailing Address - Fax:303-681-9204
Practice Address - Street 1:8520 SPRUCE MOUNTAIN ROAD
Practice Address - Street 2:SUITE 110
Practice Address - City:LARKSPUR
Practice Address - State:CO
Practice Address - Zip Code:80118
Practice Address - Country:US
Practice Address - Phone:303-681-9200
Practice Address - Fax:303-681-9204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO92011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty