Provider Demographics
NPI:1902159387
Name:DR. JOHNNY PEARCE
Entity Type:Organization
Organization Name:DR. JOHNNY PEARCE
Other - Org Name:MY DENTIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PC
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARCE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-419-9991
Mailing Address - Street 1:PO BOX 702620
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74170-2620
Mailing Address - Country:US
Mailing Address - Phone:405-286-9024
Mailing Address - Fax:
Practice Address - Street 1:3617 W SUNSET AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-4955
Practice Address - Country:US
Practice Address - Phone:479-419-9991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCE DENTAL IMPLANT AND DENTURE CENTER,LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3862122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty