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General NPI Number Information
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NPI Number | 1164878740
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Entity Type | Organization
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Legal Business Name | PINES DENTAL ASSOCIATES, P.C.
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Dates
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Enumeration Date | 05/12/2016
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Last Update Date | 05/16/2016
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Provider Practice Location Address
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Address Line | 2557 WHITNEY AVE
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City | HAMDEN
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State | CT
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Zip | 06518-3021
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Country | US
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Telephone | 203-248-7720
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Fax | 203-248-9010
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Provider Business Mailing Address
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Address Line | 2557 WHITNEY AVE
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City | HAMDEN
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State | CT
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Zip | 06518-3021
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Country | US
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Telephone | 203-248-7720
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Fax | 203-248-9010
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | BRYAN H PINES
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Credential | D.M.D.
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Telephone | 203-248-7720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 006806
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License Number State | CT
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