Provider Demographics
NPI:1235411166
Name:PINNELL, DOUGLAS CRAIG (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:CRAIG
Last Name:PINNELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17137 BREEDERS CUP DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-6203
Mailing Address - Country:US
Mailing Address - Phone:813-470-0039
Mailing Address - Fax:
Practice Address - Street 1:100 N COLLEGE AVE # 160
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-5311
Practice Address - Country:US
Practice Address - Phone:479-443-4301
Practice Address - Fax:479-587-5963
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010058531223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics