Provider Demographics
NPI:1043502123
Name:DAVID R PEARCE DDS PC
Entity Type:Organization
Organization Name:DAVID R PEARCE DDS PC
Other - Org Name:BALDWINSVILLE GENTLE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:PEARCE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-635-3671
Mailing Address - Street 1:30 WEST GENESEE ST.
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-1126
Mailing Address - Country:US
Mailing Address - Phone:315-635-3671
Mailing Address - Fax:315-635-6482
Practice Address - Street 1:30 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-1126
Practice Address - Country:US
Practice Address - Phone:315-635-3671
Practice Address - Fax:315-635-6482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-09
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044259332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6551880001Medicare NSC