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General NPI Number Information
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NPI Number | 1417802810
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Entity Type | Organization
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Legal Business Name | PINNACLE IMPLANTS AND PERIODONTICS
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Dates
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Enumeration Date | 03/02/2026
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Last Update Date | 03/02/2026
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Provider Practice Location Address
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Address Line | 444 FOREST SQ STE A
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City | LONGVIEW
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State | TX
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Zip | 75605-4463
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Country | US
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Telephone | 903-758-3329
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Fax |
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Provider Business Mailing Address
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Address Line | 444 FOREST SQ STE A
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City | LONGVIEW
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State | TX
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Zip | 75605-4463
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Country | US
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Telephone | 903-758-3329
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | JENNIFER HERITAGE
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Credential |
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Telephone | 402-805-4516
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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