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General NPI Number Information
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NPI Number | 1396579942
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Entity Type | Organization
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Legal Business Name | PINNACLE DENTAL PARTNERS
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Dates
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Enumeration Date | 08/27/2024
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Last Update Date | 08/27/2024
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Provider Practice Location Address
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Address Line | 209 W 200 N
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City | ROOSEVELT
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State | UT
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Zip | 84066-2835
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Country | US
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Telephone | 435-722-2111
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Fax |
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Provider Business Mailing Address
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Address Line | 516 W PALO VERDE WAY
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City | IVINS
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State | UT
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Zip | 84738-1207
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MATTHEW TANUVASA
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Credential |
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Telephone | 385-216-4421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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