Individual
JIMMIE L. PINKHAM JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3549 11TH AVE, COUNCIL BLUFFS, IA 51501-5641
(712) 328-0708
(712) 328-8991
Mailing address
3549 11TH AVE, COUNCIL BLUFFS, IA 51501-5641
(712) 328-0708
(712) 328-8991
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7623
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0094250
—
IA
01
—
47077917240
NE MEDICAID
NE
Enumeration date
10/13/2005
Last updated
12/20/2016
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