Provider Demographics
NPI:1851631246
Name:PINNACLE ONE DENTAL GROUP
Entity Type:Organization
Organization Name:PINNACLE ONE DENTAL GROUP
Other - Org Name:CINCINNATI DENTAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:FAUST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-721-2444
Mailing Address - Street 1:5976 MEIJER DR STE 110B
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-2191
Mailing Address - Country:US
Mailing Address - Phone:513-721-2444
Mailing Address - Fax:513-721-2398
Practice Address - Street 1:5976 MEIJER DR STE 110B
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-2191
Practice Address - Country:US
Practice Address - Phone:513-721-2444
Practice Address - Fax:513-721-2398
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CINCINNATI DENTAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14417261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental