Provider Demographics
NPI:1598003832
Name:PINNACLE ONE DENTAL GROUP
Entity Type:Organization
Organization Name:PINNACLE ONE DENTAL GROUP
Other - Org Name:CINCINNATI DENTAL SERVICES FLORENCE KENTUCKY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-2100
Mailing Address - Street 1:7766 EWING BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-7537
Mailing Address - Country:US
Mailing Address - Phone:859-568-1630
Mailing Address - Fax:
Practice Address - Street 1:7766 EWING BLVD STE 300
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-7537
Practice Address - Country:US
Practice Address - Phone:859-568-1630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PINNACLE ONE DENTAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-22
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223G0001X
OH14417261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty