Healthcare Provider Details

I. General information

NPI: 1396835583
Provider Name (Legal Business Name): KENNETH C PINKERTON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10200 WEST MAIN STREET SIGNAL HILL MEDICAL BUILDING
BELLEVILLE IL
62223-1495
US

IV. Provider business mailing address

10200 WEST MAIN STREET SIGNAL HILL MEDICAL BUILDING
BELLEVILLE IL
62223-1495
US

V. Phone/Fax

Practice location:
  • Phone: 618-397-2464
  • Fax: 618-398-4450
Mailing address:
  • Phone: 618-397-2464
  • Fax: 618-398-4450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: