Provider Demographics
NPI:1255930921
Name:PILTINGSRUD, DARLENE MARIE
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:MARIE
Last Name:PILTINGSRUD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 555221
Mailing Address - Street 2:
Mailing Address - City:CAMP PENDLETON
Mailing Address - State:CA
Mailing Address - Zip Code:92055-5221
Mailing Address - Country:US
Mailing Address - Phone:949-291-1222
Mailing Address - Fax:
Practice Address - Street 1:13128 14 TH ST
Practice Address - Street 2:
Practice Address - City:CAMP PENDELTON
Practice Address - State:CA
Practice Address - Zip Code:92055-5221
Practice Address - Country:US
Practice Address - Phone:949-291-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant