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General NPI Number Information
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NPI Number | 1205706074
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Entity Type | Organization
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Legal Business Name | PINES DENTAL VILLAGE CORP.
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Dates
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Enumeration Date | 11/07/2025
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 12558 PINES BLVD
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-1713
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Country | US
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Telephone | 954-639-6998
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Fax |
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Provider Business Mailing Address
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Address Line | 12558 PINES BLVD
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-1713
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Country | US
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Telephone | 954-639-6998
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. LIVEISYS PEDRAZA
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Credential | DDS
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Telephone | 786-337-1013
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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 |
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License Number State |
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