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General NPI Number Information
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NPI Number | 1487445003
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Entity Type | Organization
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Legal Business Name | PINES TRUE SMILE
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Dates
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Enumeration Date | 05/14/2025
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 11246 PINES BLVD
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-4101
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Country | US
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Telephone | 954-703-2474
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Fax | 954-693-6010
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Provider Business Mailing Address
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Address Line | 11246 PINES BLVD
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-4101
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Country | US
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Telephone | 954-703-2474
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Fax | 954-693-6010
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SHEILA RONQUILLO
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Credential |
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Telephone | 786-390-5716
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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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