Healthcare Provider Details

I. General information

NPI: 1538665963
Provider Name (Legal Business Name): PINNACLE ENDODONTICS OF CRABAPPLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 04/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12250 CRABAPPLE ROAD
ALPHARETTA GA
30004
US

IV. Provider business mailing address

975 PEACHTREE PKWY STE B
CUMMING GA
30041-6802
US

V. Phone/Fax

Practice location:
  • Phone: 678-341-0489
  • Fax:
Mailing address:
  • Phone: 770-624-0029
  • Fax: 770-624-0029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number14143
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14985
License Number StateGA

VIII. Authorized Official

Name: DR. CAMERON MICHAEL HOWARD
Title or Position: OWNER
Credential: DMD
Phone: 770-624-0029