MEDICARE: DR. TED M PINNEY D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	3474	AR

General Provider Information

NPI Number	:	1548353733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TED M PINNEY D.D.S.

Provider Business Mailing Address
First Line	:	815 MARSHALL RD
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72076-3744
Country	:	US
Telephone Number	:	501-982-4447
Fax Number	:	501-985-5197

Provider Business Practice Location Address
First Line	:	815 MARSHALL RD
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72076-3744
Country	:	US
Telephone Number	:	501-982-4447
Fax Number	:	501-985-5197

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/08/2007

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