Provider Demographics
NPI:1073732582
Name:PEARSON, SHAYNA ROCHELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAYNA
Middle Name:ROCHELLE
Last Name:PEARSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2569 6 1/2 AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-3203
Mailing Address - Country:US
Mailing Address - Phone:608-328-8228
Mailing Address - Fax:608-328-8230
Practice Address - Street 1:2569 6 1/2 AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-3203
Practice Address - Country:US
Practice Address - Phone:608-328-8228
Practice Address - Fax:608-328-8230
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5917-015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist