Provider Demographics
NPI:1588745426
Name:DR. KENNETH V PINESCHI DDS LTD
Entity type:Organization
Organization Name:DR. KENNETH V PINESCHI DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:PINESCHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-968-6688
Mailing Address - Street 1:1506 N ROCKTON AVE
Mailing Address - Street 2:KENNETH V PINESCHI DDS LTD
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-4388
Mailing Address - Country:US
Mailing Address - Phone:815-968-6688
Mailing Address - Fax:815-968-8989
Practice Address - Street 1:1506 N ROCKTON AVE
Practice Address - Street 2:KENNETH V PINESCHI DDS LTD
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103-4388
Practice Address - Country:US
Practice Address - Phone:815-968-6688
Practice Address - Fax:815-968-8989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190161431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019016143Medicaid