Provider Demographics
NPI:1649388489
Name:PINNIX AND BETANCOURT PLLC
Entity Type:Organization
Organization Name:PINNIX AND BETANCOURT PLLC
Other - Org Name:ADVANCED DENTISTRY OF BLAKENEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/CO-PRESIDENT/CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:BETANCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:704-543-1102
Mailing Address - Street 1:8918 BLAKENEY PROFESSIONAL DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277
Mailing Address - Country:US
Mailing Address - Phone:704-543-1102
Mailing Address - Fax:704-543-1028
Practice Address - Street 1:8918 BLAKENEY PROFESSIONAL DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277
Practice Address - Country:US
Practice Address - Phone:704-543-1102
Practice Address - Fax:704-543-1028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223G0001X
NC78821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1508940826OtherGEORGE A. BETANCOURT, DMD
NC1811169022OtherTHOMAS D. GRIMES, DDS
NC1215109426OtherADVANCED DENTISTRY
NC1396828380OtherCHRISTOPHER PHELPS, DMD
NC1962571984OtherJOHN PINNIX, DMD