Provider Demographics
NPI:1801961859
Name:PINCOCK, JAMES LOWELL (MD DMD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:LOWELL
Last Name:PINCOCK
Suffix:
Gender:M
Credentials:MD DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1470 MEDICAL PKWY
Mailing Address - Street 2:STE #260
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-4648
Mailing Address - Country:US
Mailing Address - Phone:775-884-4433
Mailing Address - Fax:775-884-4459
Practice Address - Street 1:1470 MEDICAL PARKWAY
Practice Address - Street 2:STE #260
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703
Practice Address - Country:US
Practice Address - Phone:775-884-4433
Practice Address - Fax:775-884-4459
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVMD6631174400000X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1801961859Medicaid
NVVMD6631Medicare ID - Type Unspecified
NV1801961859Medicare PIN
C70942Medicare UPIN