Healthcare Provider Details

I. General information

NPI: 1972093904
Provider Name (Legal Business Name): DENTISTS OF PINES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10430 PINES BLVD STE C103
PEMBROKE PINES FL
33026-6049
US

IV. Provider business mailing address

17000 RED HILL AVE
IRVINE CA
92614-5626
US

V. Phone/Fax

Practice location:
  • Phone: 954-251-0238
  • Fax:
Mailing address:
  • Phone: 714-845-8280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. MINH B PHAM
Title or Position: OWNER
Credential: DDS
Phone: 954-251-0238