Provider Demographics
NPI:1447249230
Name:ASSOCIATE DENTISTS, P.C.
Entity type:Organization
Organization Name:ASSOCIATE DENTISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JIMMIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PINKHAM
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:712-328-0708
Mailing Address - Street 1:3549 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-5641
Mailing Address - Country:US
Mailing Address - Phone:712-328-0708
Mailing Address - Fax:712-328-8991
Practice Address - Street 1:3549 11TH AVE
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-5641
Practice Address - Country:US
Practice Address - Phone:712-328-0708
Practice Address - Fax:712-328-8991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA76231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0094250Medicaid
NE=========40OtherNE MEDICAID