Provider Demographics
NPI:1730482241
Name:PINNIX, GRIMES, BETANCOURT & PHELPS, DDL PLLC
Entity type:Organization
Organization Name:PINNIX, GRIMES, BETANCOURT & PHELPS, DDL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:PHELPS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:704-543-1102
Mailing Address - Street 1:621 BIRCHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-6559
Mailing Address - Country:US
Mailing Address - Phone:704-243-1122
Mailing Address - Fax:704-243-1251
Practice Address - Street 1:621 BIRCHWOOD DR
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-6559
Practice Address - Country:US
Practice Address - Phone:704-243-1122
Practice Address - Fax:704-243-1251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7648305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service