MEDICARE: DR. JAY CRAIG PINKNER DDS

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	122300000X	Dentist	8268	CO

General Provider Information

NPI Number	:	1477641314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY CRAIG PINKNER DDS

Provider Business Mailing Address
First Line	:	1361 FRANCIS ST
Second Line	:	SUITE 201
City	:	LONGMONT
State	:	CO
Zip	:	80501-2576
Country	:	US
Telephone Number	:	303-776-0117
Fax Number	:	720-494-9286

Provider Business Practice Location Address
First Line	:	1361 FRANCIS ST
Second Line	:	SUITE 201
City	:	LONGMONT
State	:	CO
Zip	:	80501-2576
Country	:	US
Telephone Number	:	303-776-0117
Fax Number	:	720-494-9286

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/08/2007

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