Provider Demographics
NPI:1083638985
Name:PEARSON, ANDREA MEREDITH (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:MEREDITH
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 1:9715 NE 120TH PL
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-4275
Mailing Address - Country:US
Mailing Address - Phone:206-579-5163
Mailing Address - Fax:
Practice Address - Street 1:11250 KIRKLAND WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-3421
Practice Address - Country:US
Practice Address - Phone:425-739-9093
Practice Address - Fax:425-822-3677
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA10015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5049358Medicaid