Provider Demographics
NPI:1457360018
Name:PINEO FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:PINEO FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:PINEO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:814-734-4451
Mailing Address - Street 1:606 ERIE ST
Mailing Address - Street 2:
Mailing Address - City:EDINBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16412-6002
Mailing Address - Country:US
Mailing Address - Phone:814-734-4451
Mailing Address - Fax:814-734-2863
Practice Address - Street 1:606 ERIE ST
Practice Address - Street 2:
Practice Address - City:EDINBORO
Practice Address - State:PA
Practice Address - Zip Code:16412-6002
Practice Address - Country:US
Practice Address - Phone:814-734-4451
Practice Address - Fax:814-734-2863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0351691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1384880OtherBCBS
PA1011637470001Medicaid
1384880OtherBCBS