Provider Demographics
NPI:1447314208
Name:PINEDA, MARY ANN (DMD)
Entity type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:PINEDA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 BRIGHTON HILL RD
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ME
Mailing Address - Zip Code:04258-4045
Mailing Address - Country:US
Mailing Address - Phone:925-331-0741
Mailing Address - Fax:
Practice Address - Street 1:1 WILLOW RUN # 1-B
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-8501
Practice Address - Country:US
Practice Address - Phone:207-783-0261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2023-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN49251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA770592433OtherTIN