Provider Demographics
NPI:1871791541
Name:PINA, PATRICIA M (DDS)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:M
Last Name:PINA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 WINDING BROOK WAY
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070
Mailing Address - Country:US
Mailing Address - Phone:860-408-9549
Mailing Address - Fax:
Practice Address - Street 1:710 KING ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4477
Practice Address - Country:US
Practice Address - Phone:860-583-8469
Practice Address - Fax:860-583-8470
Is Sole Proprietor?:No
Enumeration Date:2007-07-04
Last Update Date:2012-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT108811223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry