Organization
PINE STREET DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OMAR FIGUEROA-VALLE DDS (OWNER)
(864) 582-5000
Entity
Organization
Contact information
Practice address
364 S PINE ST STE A101, SPARTANBURG, SC 29302-2654
(864) 582-5000
(864) 582-3756
Mailing address
364 S PINE ST STE A101, SPARTANBURG, SC 29302-2654
(864) 582-5000
(864) 582-3756
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1538535620
NPI
—
Enumeration date
07/10/2017
Last updated
07/21/2022
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