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Organization
PINES DENTAL VILLAGE CORP.
Active
Organization
PINES DENTAL VILLAGE CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LIVEISYS PEDRAZA DDS (OWNER)
(786) 337-1013
Entity
Organization
Contact information
Practice address
12558 PINES BLVD, PEMBROKE PINES, FL 33027-1713
(954) 639-6998
Mailing address
12558 PINES BLVD, PEMBROKE PINES, FL 33027-1713
(954) 639-6998
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
11/07/2025
Last updated
11/07/2025
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