Provider Demographics
NPI:1336178854
Name:PINE, STEVEN L (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:L
Last Name:PINE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6378 BUSCH BLVD
Mailing Address - Street 2:APT. # 397
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-1813
Mailing Address - Country:US
Mailing Address - Phone:614-430-8485
Mailing Address - Fax:
Practice Address - Street 1:1395 E DUBLIN GRANVILLE RD
Practice Address - Street 2:SUITE # 404
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-3314
Practice Address - Country:US
Practice Address - Phone:614-885-0323
Practice Address - Fax:614-885-2544
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH178191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice