Pine Ridge Dental, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

PINE RIDGE DENTAL, PLLC

Practice address

541 Main St
Longmont, CO 80501-5536

Phone

(303) 776-0312

Fax

(303) 776-0312

NPI assigned

Jan 13, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nick Sundiam

Title

Credentialing Manager

Phone

(719) 300-5933

Specialties & licenses 1

Addresses

Other names 1

• Pine Ridge Dental Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1736726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736726400000",
    "number": "1881404564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "541 MAIN ST",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805015536",
            "telephone_number": "303-776-0312",
            "fax_number": "303-776-0312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "541 MAIN ST",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805015536",
            "telephone_number": "303-776-0312",
            "fax_number": "303-776-0312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE RIDGE DENTAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-13",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A",
        "authorized_official_last_name": "SUNDIAM",
        "authorized_official_first_name": "NICK",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "719-300-5933"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pine Ridge Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Hannah Pierce, PA-C
• Dianne Renee Pierson, DDS
• Cynthia Pillmore, M.A., CACIII
• Mark Pimper, D.D.S.
• Diane Pincus, MD
• Margaret A Pine, MSW, LCSW
• Megan Pinkerton, PA-C
• Jay Craig Pinkner, DDS
• Stephanie Pipp, PT, DPT
• Sean Pippen, MD

• General Practice Dentistry in Longmont, CO
• Providers in Longmont, CO by specialty
• General Practice Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.