Healthcare Provider Details

I. General information

NPI: 1780774992
Provider Name (Legal Business Name): JOHN DICKENS PINCH D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

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

1942 THOMSON DR
LYNCHBURG VA
24501-1009
US

IV. Provider business mailing address

1942 THOMSON DR
LYNCHBURG VA
24501-1009
US

V. Phone/Fax

Practice location:
  • Phone: 434-947-5915
  • Fax:
Mailing address:
  • Phone: 434-947-5915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0401-005827
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: