NPIMap

Organization Active NPI

Pinnacle Periodontics

Doing business as Pinnacle Periodontics & Dental Implant Center

  • Periodontics
  • Little Rock, AR
National Provider Identifier
1396189270
Registry record updated Apr 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
3613 Issued in AR
Legal business name
PINNACLE PERIODONTICS
Doing business as
Pinnacle Periodontics & Dental Implant Center
Practice address
1225 Breckenridge Dr
#110
Little Rock, AR 72205-1558
Phone
(501) 225-4644
Fax
(501) 225-4102
NPI assigned
Apr 23, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Matthew D Carlisle, D.D.S., M.S.NPI 1356538656
Title
Owner/Periodontist
Phone
(501) 225-4644

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0300X 3613 AR Primary

Addresses

Primary practice location

1225 Breckenridge Dr
#110
Little Rock, AR 72205-1558

Mailing address

1225 Breckenridge Dr
#110
Little Rock, AR 72205-1558
Phone (501) 225-4644

Other identifiers 1

IdentifierTypeStateIssuer
195700679MedicaidAR

Other names 1

  • Pinnacle Periodontics & Dental Implant Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pinnacle Periodontics2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1366675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366675200000",
    "number": "1396189270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1225 BRECKENRIDGE DR",
            "address_2": "#110",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722051558",
            "telephone_number": "501-225-4644",
            "fax_number": "501-225-4102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 BRECKENRIDGE DR",
            "address_2": "#110",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722051558",
            "telephone_number": "501-225-4644",
            "fax_number": "501-225-4102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINNACLE PERIODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-23",
        "last_updated": "2013-04-23",
        "status": "A",
        "authorized_official_last_name": "CARLISLE",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER/PERIODONTIST",
        "authorized_official_telephone_number": "501-225-4644",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S., M.S."
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "AR",
            "license": "3613",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "195700679",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pinnacle Periodontics & Dental Implant Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Little Rock, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.