Provider Demographics
NPI:1679086136
Name:PINSON FAMILY DENTISTRY, PC
Entity type:Organization
Organization Name:PINSON FAMILY DENTISTRY, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:DANE
Authorized Official - Last Name:GROVENSTEIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-680-1120
Mailing Address - Street 1:6727 DEERFOOT PKWY
Mailing Address - Street 2:
Mailing Address - City:PINSON
Mailing Address - State:AL
Mailing Address - Zip Code:35126-3093
Mailing Address - Country:US
Mailing Address - Phone:250-680-1120
Mailing Address - Fax:205-680-8806
Practice Address - Street 1:6727 DEERFOOT PKWY
Practice Address - Street 2:
Practice Address - City:PINSON
Practice Address - State:AL
Practice Address - Zip Code:35126-3093
Practice Address - Country:US
Practice Address - Phone:250-680-1120
Practice Address - Fax:205-680-8806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6302261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1659721587Medicaid