Provider Demographics
NPI:1255925061
Name:PINHO, DIANA PEREIRA (RDH)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:PEREIRA
Last Name:PINHO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 WILLARD AVE
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-1234
Mailing Address - Country:US
Mailing Address - Phone:860-519-7573
Mailing Address - Fax:
Practice Address - Street 1:1540 PLEASANT VALLEY RD STE G
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-8760
Practice Address - Country:US
Practice Address - Phone:860-644-1095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009198124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist