Provider Demographics
NPI:1336473982
Name:BETANCOURT, PINNIX, PHELPS, & GRIMES DMD PLLC
Entity Type:Organization
Organization Name:BETANCOURT, PINNIX, PHELPS, & GRIMES DMD PLLC
Other - Org Name:PARKWOOD DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COPRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:LATHAM
Authorized Official - Last Name:PHELPS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:704-845-1107
Mailing Address - Street 1:400 PARKWOOD MEDICAL PARK
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-2485
Mailing Address - Country:US
Mailing Address - Phone:336-835-5579
Mailing Address - Fax:336-835-2639
Practice Address - Street 1:400 PARKWOOD MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2485
Practice Address - Country:US
Practice Address - Phone:336-835-5579
Practice Address - Fax:336-835-2639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC76481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty