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General NPI Number Information
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NPI Number | 1730296435
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Entity Type | Organization
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Legal Business Name | PHILIP A. PINE DDS PA.
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1600 E ATLANTIC BLVD
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City | POMPANO BEACH
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State | FL
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Zip | 33060-6768
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Country | US
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Telephone | 954-782-1992
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 E ATLANTIC BLVD
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City | POMPANO BEACH
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State | FL
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Zip | 33060-6768
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Country | US
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Telephone | 954-782-1992
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PHILIP PINE
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Credential |
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Telephone | 954-782-1992
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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 | 10129
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License Number State | FL
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