Provider Demographics
NPI:1881992659
Name:THOMAS PINNAVAIA, PLLC
Entity type:Organization
Organization Name:THOMAS PINNAVAIA, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEENA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PHINMVONGSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-375-8577
Mailing Address - Street 1:411 BILLINGSLEY RD.
Mailing Address - Street 2:STE. 102
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211
Mailing Address - Country:US
Mailing Address - Phone:704-375-8577
Mailing Address - Fax:980-276-3154
Practice Address - Street 1:411 BILLINGSLEY RD.
Practice Address - Street 2:STE 102
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211
Practice Address - Country:US
Practice Address - Phone:704-375-8577
Practice Address - Fax:704-331-9987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-03
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5251122300000X
122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty