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General NPI Number Information
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NPI Number | 1992596811
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Entity Type | Organization
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Legal Business Name | PINES DENTAL PA
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Dates
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Enumeration Date | 05/13/2025
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 7744 PETERS RD
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City | PLANTATION
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State | FL
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Zip | 33324-4004
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Country | US
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Telephone | 954-905-6633
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Fax | 954-302-6898
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Provider Business Mailing Address
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Address Line | 7744 PETERS RD
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City | PLANTATION
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State | FL
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Zip | 33324-4004
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Country | US
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Telephone | 954-905-6633
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Fax | 954-302-6898
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Authorized Official
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Title or Position | OWNER
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Name | RODOLFO OLMOS
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Credential |
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Telephone | 407-951-0335
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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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