Provider Demographics
NPI:1396299947
Name:PINKSTON, CARMEN RAQUEL (RDH)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:RAQUEL
Last Name:PINKSTON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2434 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38114-5851
Mailing Address - Country:US
Mailing Address - Phone:901-237-8512
Mailing Address - Fax:
Practice Address - Street 1:2348 PARK AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38114-6638
Practice Address - Country:US
Practice Address - Phone:901-327-6166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDH6372124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist