Healthcare Provider Details

I. General information

NPI: 1316325202
Provider Name (Legal Business Name): PINNACLE DENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 03/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

959 BRUSH HOLLOW RD
WESTBURY NY
11590-1778
US

IV. Provider business mailing address

959 BRUSH HOLLOW RD
WESTBURY NY
11590-1778
US

V. Phone/Fax

Practice location:
  • Phone: 516-333-3033
  • Fax:
Mailing address:
  • Phone: 516-333-3033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number50077
License Number StateNY

VIII. Authorized Official

Name: DR. GLEN EHRENMAN
Title or Position: PEDIATRIC DENTIST
Credential: DDS
Phone: 516-333-3033