Healthcare Provider Details

I. General information

NPI: 1598868994
Provider Name (Legal Business Name): JACQUES SCOTT PINKARD DDS MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 LINCOLN AVENUE
MARQUETTE MI
49855-2620
US

IV. Provider business mailing address

1029 LINCOLN AVENUE
MARQUETTE MI
49855-2620
US

V. Phone/Fax

Practice location:
  • Phone: 906-228-6310
  • Fax: 906-228-6345
Mailing address:
  • Phone: 906-228-6310
  • Fax: 906-228-6345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2901013638
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: