Healthcare Provider Details

I. General information

NPI: 1851554992
Provider Name (Legal Business Name): JOAN MANUEL PINO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 VALLEY VISTA DRIVE
WOODSTOCK VA
22664
US

IV. Provider business mailing address

124 VALLEY VISTA DR
WOODSTOCK VA
22664-1608
US

V. Phone/Fax

Practice location:
  • Phone: 540-459-9333
  • Fax:
Mailing address:
  • Phone: 540-459-9333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number04014142222
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: