Provider Demographics
NPI:1558663260
Name:PINNACLE PEDIATRIC DENTISTRY, PLLC
Entity Type:Organization
Organization Name:PINNACLE PEDIATRIC DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOI
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:713-863-7336
Mailing Address - Street 1:3939 WASHINGTON AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-5603
Mailing Address - Country:US
Mailing Address - Phone:713-863-7336
Mailing Address - Fax:713-863-7606
Practice Address - Street 1:3939 WASHINGTON AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-5603
Practice Address - Country:US
Practice Address - Phone:713-863-7336
Practice Address - Fax:713-863-7606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX237581223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty