Provider Demographics
NPI:1477618643
Name:KIMBERLY S. PINYAN, DMD, PA
Entity Type:Organization
Organization Name:KIMBERLY S. PINYAN, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:PINYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:336-760-2011
Mailing Address - Street 1:4712 COUNTRY CLUB RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-3749
Mailing Address - Country:US
Mailing Address - Phone:336-760-2011
Mailing Address - Fax:336-760-2847
Practice Address - Street 1:4712 COUNTRY CLUB RD
Practice Address - Street 2:SUITE C
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-3749
Practice Address - Country:US
Practice Address - Phone:336-760-2011
Practice Address - Fax:336-760-2847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20000132336071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty