Provider Demographics
NPI:1730594508
Name:PEARSON, PC
Entity type:Organization
Organization Name:PEARSON, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-578-6358
Mailing Address - Street 1:3250 SE 164TH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-9312
Mailing Address - Country:US
Mailing Address - Phone:360-891-1999
Mailing Address - Fax:360-944-8884
Practice Address - Street 1:3250 SE 164TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-9312
Practice Address - Country:US
Practice Address - Phone:360-891-1999
Practice Address - Fax:360-944-8884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-30
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00011063122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty