Provider Demographics
NPI:1891044236
Name:PINKERT, TRISTA S (RDH)
Entity Type:Individual
Prefix:
First Name:TRISTA
Middle Name:S
Last Name:PINKERT
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 FARNAM ST
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-5761
Mailing Address - Country:US
Mailing Address - Phone:715-514-9870
Mailing Address - Fax:
Practice Address - Street 1:1617 FARNAM ST
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-5761
Practice Address - Country:US
Practice Address - Phone:715-514-9870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11177-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist