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General NPI Number Information
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NPI Number | 1417092255
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Entity Type | Individual
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Provider Name | BRUCE J PINES D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 115 FRANKLIN TPKE
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City | MAHWAH
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State | NJ
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Zip | 07430-1325
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Country | US
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Telephone | 201-529-4441
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Fax | 201-529-1255
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Provider Business Mailing Address
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Address Line | 818 HIGH MOUNTAIN RD
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City | FRANKLIN LAKES
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State | NJ
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Zip | 07417-1618
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Country | US
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Telephone | 201-848-9541
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 13781
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License Number State | NJ
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