Healthcare Provider Details

I. General information

NPI: 1528714615
Provider Name (Legal Business Name): PINNACLE PEDIATRIC DENTISTRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2022
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 ACE DR
BEREA KY
40403-1327
US

IV. Provider business mailing address

272 DEERFIELD LN
LEXINGTON KY
40511-8784
US

V. Phone/Fax

Practice location:
  • Phone: 859-286-6999
  • Fax: 859-406-1333
Mailing address:
  • Phone: 859-420-9187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ERIC JACOBSON
Title or Position: MEMBER
Credential: DMD
Phone: 859-420-9187