Healthcare Provider Details

I. General information

NPI: 1861492456
Provider Name (Legal Business Name): DR. GINA B. PINAMONTI
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2602 S ROUSE ST
PITTSBURG KS
66762-6632
US

IV. Provider business mailing address

2602 S ROUSE ST
PITTSBURG KS
66762-6632
US

V. Phone/Fax

Practice location:
  • Phone: 620-231-6910
  • Fax: 620-231-6918
Mailing address:
  • Phone: 620-231-6910
  • Fax: 620-231-6918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number7045
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: