Provider Demographics
NPI:1003823055
Name:PIERSON, KEVIN M (DDS)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:M
Last Name:PIERSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11145 HIGHWAY 135 NE
Mailing Address - Street 2:
Mailing Address - City:NEW SALISBURY
Mailing Address - State:IN
Mailing Address - Zip Code:47161-9224
Mailing Address - Country:US
Mailing Address - Phone:812-364-4111
Mailing Address - Fax:
Practice Address - Street 1:11145 HIGHWAY 135 NE
Practice Address - Street 2:
Practice Address - City:NEW SALISBURY
Practice Address - State:IN
Practice Address - Zip Code:47161-9224
Practice Address - Country:US
Practice Address - Phone:812-364-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120080181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice