MEDICARE: PINNACLE ONE DENTAL GROUP

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	1223G0001X	General Practice Dentistry	14417	OH

General Provider Information

NPI Number	:	1730106253
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINNACLE ONE DENTAL GROUP

Provider Business Mailing Address
First Line	:	8111 CHEVIOT RD STE 102
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45247-4013
Country	:	US
Telephone Number	:	513-741-7779
Fax Number	:

Provider Business Practice Location Address
First Line	:	8111 CHEVIOT RD STE 102
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45247-4013
Country	:	US
Telephone Number	:	513-741-7779
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	CELIA HAYES
Credential	:
Telephone Number	:	217-540-2100

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	02/11/2022

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