Provider Demographics
NPI:1053367813
Name:PIERCE, DINO PAUL (CFT, CPT, RD, CDE)
Entity type:Individual
Prefix:MR
First Name:DINO
Middle Name:PAUL
Last Name:PIERCE
Suffix:
Gender:M
Credentials:CFT, CPT, RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4722 N. CENTRAL ST.
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-5087
Mailing Address - Country:US
Mailing Address - Phone:928-692-4608
Mailing Address - Fax:928-692-4610
Practice Address - Street 1:1719 BEVERLY AVE.
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409
Practice Address - Country:US
Practice Address - Phone:928-692-4608
Practice Address - Fax:928-692-4610
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD1210133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered