Provider Demographics
NPI:1174665616
Name:PINNACLE DENTAL GROUP
Entity type:Organization
Organization Name:PINNACLE DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YOSIF
Authorized Official - Middle Name:
Authorized Official - Last Name:JABIR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-436-1530
Mailing Address - Street 1:13530 S ROUTE 59
Mailing Address - Street 2:SUITE J
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-5658
Mailing Address - Country:US
Mailing Address - Phone:815-436-1530
Mailing Address - Fax:815-436-4496
Practice Address - Street 1:13530 S ROUTE 59
Practice Address - Street 2:SUITE J
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-5658
Practice Address - Country:US
Practice Address - Phone:815-436-1530
Practice Address - Fax:815-436-4496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty