1760537450 NPI number — PINNACLE HILLS DENTAL GROUP

Table of content: (NPI 1760537450)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760537450 NPI number — PINNACLE HILLS DENTAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINNACLE HILLS DENTAL GROUP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
L.B. STRINGFELLOW. D.D.S., P.A.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760537450
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
811 S.E 28TH ST.
Provider Second Line Business Mailing Address:
STE #7
Provider Business Mailing Address City Name:
BENTONVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-254-9494
Provider Business Mailing Address Fax Number:
479-254-6850

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
811 SE 28TH ST.
Provider Second Line Business Practice Location Address:
STE #7
Provider Business Practice Location Address City Name:
BENTONVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-254-9494
Provider Business Practice Location Address Fax Number:
479-254-6850
Provider Enumeration Date:
01/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STRINGFELLOW
Authorized Official First Name:
LOREN
Authorized Official Middle Name:
Authorized Official Title or Position:
PROVIDER
Authorized Official Telephone Number:
479-254-9494

Provider Taxonomy Codes

  • Taxonomy code: 1223E0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223X0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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