MEDICARE: PINNACLE IMPLANTS AND PERIODONTICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics

General Provider Information

NPI Number	:	1417802810
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINNACLE IMPLANTS AND PERIODONTICS

Provider Business Mailing Address
First Line	:	444 FOREST SQ STE A
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75605-4463
Country	:	US
Telephone Number	:	903-758-3329
Fax Number	:

Provider Business Practice Location Address
First Line	:	444 FOREST SQ STE A
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75605-4463
Country	:	US
Telephone Number	:	903-758-3329
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	JENNIFER HERITAGE
Credential	:
Telephone Number	:	402-805-4516

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/09/2026

Similar Medicare Providers

1124158092 — ALFRED HARRIS FOWLER III DDS
Practice Location Address:

444 FOREST SQUARE , SUITE D
LONGVIEW, TX
75605-4463

Practice Phone: 903-236-8538
Practice Fax: 903-236-8539

1649303397 — DR. WILLIAM RONEU REAGAN D.D.S.
Practice Location Address:

444 FOREST SQ
LONGVIEW, TX
75605-4463

Practice Phone: 903-758-4431
Practice Fax: 903-753-5458

1780844977 — TOM M SMITH, DDS, INC
Practice Location Address:

444 FOREST SQ , SUITE A
LONGVIEW, TX
75605-4463

Practice Phone: 903-758-3329
Practice Fax: 903-758-4784

1225341522 — DR. MICHEL VICTOR FURTADO ARAUJO DDS, MSC, MDS
Practice Location Address:

444 FOREST SQ , SUITE A
LONGVIEW, TX
75605-4463

Practice Phone: 903-758-3329
Practice Fax:

1841641669 — KOPEMAK DENTAL SPECIALISTS, PLLC
Practice Location Address:

444 FOREST SQ , SUITE A
LONGVIEW, TX
75605-4463

Practice Phone: 903-758-3329
Practice Fax:

1295239713 — ERICK EVANDRO DI MATTEO
Practice Location Address:

444 FOREST SQ STE A
LONGVIEW, TX
75605-4463

Practice Phone: 903-758-3329
Practice Fax:

Directions to “PINNACLE IMPLANTS AND PERIODONTICS ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.