Provider Demographics
NPI:1417187048
Name:PINNEY, BENJAMIN LARS (DMD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:LARS
Last Name:PINNEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 WILLOUGHBY AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-1700
Mailing Address - Country:US
Mailing Address - Phone:907-586-1385
Mailing Address - Fax:
Practice Address - Street 1:400 WILLOUGHBY AVE STE 208
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1700
Practice Address - Country:US
Practice Address - Phone:907-586-1385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK12881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice