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General NPI Number Information
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NPI Number | 1336580919
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Entity Type | Individual
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Provider Name | PATRICIA M PINE RDH,OM
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Gender | Female
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Dates
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Enumeration Date | 07/11/2013
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Last Update Date | 07/11/2013
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Provider Practice Location Address
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Address Line | 16422 E CRYSTAL RIDGE DR
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City | FOUNTAIN HILLS
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State | AZ
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Zip | 85268-8415
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Country | US
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Telephone | 847-207-7463
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Fax |
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Provider Business Mailing Address
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Address Line | 16422 E CRYSTAL RIDGE DR
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City | FOUNTAIN HILLS
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State | AZ
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Zip | 85268-8415
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Country | US
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Telephone | 847-207-7463
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | H4381
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 020-004876
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 6743-016
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License Number State | WI
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