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General NPI Number Information
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NPI Number | 1629808779
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Entity Type | Organization
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Legal Business Name | PIINNACLE DENTAL PARRTNERS
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Dates
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Enumeration Date | 08/05/2024
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 533 W STATE RD STE 201
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-2116
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Country | US
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Telephone | 385-216-4421
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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 | 385-216-4421
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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 | 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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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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Taxonomy #4
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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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Taxonomy #5
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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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Taxonomy #6
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #7
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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 #8
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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