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General NPI Number Information
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NPI Number | 1528714615
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Entity Type | Organization
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Legal Business Name | PINNACLE PEDIATRIC DENTISTRY, PLLC
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Dates
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Enumeration Date | 02/27/2022
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Last Update Date | 02/27/2022
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Provider Practice Location Address
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Address Line | 1006 ACE DR
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City | BEREA
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State | KY
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Zip | 40403-1327
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Country | US
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Telephone | 859-286-6999
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Fax | 859-406-1333
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Provider Business Mailing Address
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Address Line | 272 DEERFIELD LN
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City | LEXINGTON
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State | KY
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Zip | 40511-8784
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Country | US
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Telephone | 859-420-9187
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | ERIC JACOBSON
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Credential | DMD
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Telephone | 859-420-9187
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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