Provider Demographics
NPI:1841979523
Name:PINNACLE DENTAL GROUP PLLC
Entity type:Organization
Organization Name:PINNACLE DENTAL GROUP PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAWLAT
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-379-3093
Mailing Address - Street 1:6323 GLYNDEBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-2212
Mailing Address - Country:US
Mailing Address - Phone:248-379-3093
Mailing Address - Fax:
Practice Address - Street 1:1262 N MACOMB ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-3197
Practice Address - Country:US
Practice Address - Phone:734-241-6166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-11
Last Update Date:2023-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty