Provider Demographics
NPI:1609815679
Name:PINNACLE ORTHODONTICS, INC. - ROBERT N. PHAM, D.D.S., M.S.
Entity Type:Organization
Organization Name:PINNACLE ORTHODONTICS, INC. - ROBERT N. PHAM, D.D.S., M.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:N
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:614-866-3411
Mailing Address - Street 1:1501 STONECREEK DR S
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-9838
Mailing Address - Country:US
Mailing Address - Phone:614-866-3411
Mailing Address - Fax:614-866-2544
Practice Address - Street 1:1501 STONECREEK DR S
Practice Address - Street 2:SUITE 102
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-9838
Practice Address - Country:US
Practice Address - Phone:614-866-3411
Practice Address - Fax:614-866-2544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH211301223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty