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General NPI Number Information
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NPI Number | 1982997441
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Entity Type | Organization
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Legal Business Name | PINNACLE IMPLANTS
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Dates
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Enumeration Date | 05/17/2011
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Last Update Date | 05/17/2011
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Provider Practice Location Address
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Address Line | 15333 N PIMA RD SUITE 103
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City | SCOTTSDALE
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State | AZ
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Zip | 85260
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Country | US
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Telephone | 623-388-4932
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Fax | 602-298-1391
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Provider Business Mailing Address
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Address Line | 15333 N PIMA RD SUITE 103
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City | SCOTTSDALE
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State | AZ
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Zip | 85260
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Country | US
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Telephone | 623-388-4932
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Fax | 602-298-1391
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Authorized Official
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Title or Position | PRODUCTION MANAGER
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Name | MR. JESSE DAVID LAIZURE
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Credential |
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Telephone | 623-388-4932
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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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 #3
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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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