MEDICARE: RYAN MARC PINES DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	22DI02610100	NJ

General Provider Information

NPI Number	:	1376928374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN MARC PINES DDS

Provider Business Mailing Address
First Line	:	115 FRANKLIN TPKE
Second Line	:
City	:	MAHWAH
State	:	NJ
Zip	:	07430-1325
Country	:	US
Telephone Number	:	201-529-4441
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 FRANKLIN TPKE
Second Line	:
City	:	MAHWAH
State	:	NJ
Zip	:	07430-1325
Country	:	US
Telephone Number	:	201-529-4441
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2015
Last Update Date	:	07/21/2015

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