Organization
PINE RIDGE DENTAL, PLLC
Active
Other names
Pine Ridge Dental
Organization subpart
No
Provider details
NPI number
Authorized official
NICK SUNDIAM (CREDENTIALING MANAGER)
(719) 300-5933
Entity
Organization
Contact information
Practice address
541 MAIN ST, LONGMONT, CO 80501-5536
(303) 776-0312
(303) 776-0312
Mailing address
541 MAIN ST, LONGMONT, CO 80501-5536
(303) 776-0312
(303) 776-0312
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
01/13/2025
Last updated
01/13/2025
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