Healthcare Provider Details

I. General information

NPI: 1982997441
Provider Name (Legal Business Name): PINNACLE IMPLANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2011
Last Update Date: 05/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15333 N PIMA RD SUITE 103
SCOTTSDALE AZ
85260
US

IV. Provider business mailing address

15333 N PIMA RD SUITE 103
SCOTTSDALE AZ
85260
US

V. Phone/Fax

Practice location:
  • Phone: 623-388-4932
  • Fax: 602-298-1391
Mailing address:
  • Phone: 623-388-4932
  • Fax: 602-298-1391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: MR. JESSE DAVID LAIZURE
Title or Position: PRODUCTION MANAGER
Credential:
Phone: 623-388-4932