Provider Demographics
NPI:1003987157
Name:PINNOCK, ALYSSA HILLMAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:HILLMAN
Last Name:PINNOCK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 SW 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33315-1024
Mailing Address - Country:US
Mailing Address - Phone:954-294-2363
Mailing Address - Fax:
Practice Address - Street 1:829 SOUTH FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:DANIA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33004-3212
Practice Address - Country:US
Practice Address - Phone:954-925-2977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-12
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN176101223P0221X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL076731000Medicaid