Provider Demographics
NPI:1841334919
Name:PINCKNEY FAMILY DENTISTRY
Entity type:Organization
Organization Name:PINCKNEY FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMRAJ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-878-3145
Mailing Address - Street 1:1243 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PINCKNEY
Mailing Address - State:MI
Mailing Address - Zip Code:48169
Mailing Address - Country:US
Mailing Address - Phone:734-878-3145
Mailing Address - Fax:734-878-0948
Practice Address - Street 1:1243 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:PINCKNEY
Practice Address - State:MI
Practice Address - Zip Code:48169
Practice Address - Country:US
Practice Address - Phone:734-878-3145
Practice Address - Fax:734-878-0948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0118611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty