Provider Demographics
NPI:1811192578
Name:PINCHBACK, ALLAN LANE (DDS)
Entity type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:LANE
Last Name:PINCHBACK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 E CORPUS CHRISTI ST
Mailing Address - Street 2:STE C
Mailing Address - City:BEEVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78102-5600
Mailing Address - Country:US
Mailing Address - Phone:361-358-5151
Mailing Address - Fax:361-358-5502
Practice Address - Street 1:106 E CORPUS CHRISTI ST
Practice Address - Street 2:STE C
Practice Address - City:BEEVILLE
Practice Address - State:TX
Practice Address - Zip Code:78102-5600
Practice Address - Country:US
Practice Address - Phone:361-358-5151
Practice Address - Fax:361-358-5502
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX094231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice