Provider Demographics
NPI:1376940361
Name:PINNACLE DENTAL IMPLANTS
Entity Type:Organization
Organization Name:PINNACLE DENTAL IMPLANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:JACK
Authorized Official - Last Name:PRITCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:254-933-7429
Mailing Address - Street 1:2429 BAYLOR CAMP RD
Mailing Address - Street 2:
Mailing Address - City:CRAWFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76638-3095
Mailing Address - Country:US
Mailing Address - Phone:254-933-7429
Mailing Address - Fax:254-933-7521
Practice Address - Street 1:2429 BAYLOR CAMP RD
Practice Address - Street 2:
Practice Address - City:CRAWFORD
Practice Address - State:TX
Practice Address - Zip Code:76638-3095
Practice Address - Country:US
Practice Address - Phone:254-848-4255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108801223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty