Provider Demographics
NPI:1093824708
Name:PEARSON, PAMELA ZENOBIA (DDS PA)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ZENOBIA
Last Name:PEARSON
Suffix:
Gender:F
Credentials:DDS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 NORTH ROAD STREET STE J
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909
Mailing Address - Country:US
Mailing Address - Phone:252-335-5302
Mailing Address - Fax:252-335-9303
Practice Address - Street 1:1141 NORTH ROAD STREET STE J
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909
Practice Address - Country:US
Practice Address - Phone:252-335-5302
Practice Address - Fax:252-335-9303
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4934122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8996767Medicaid
795795OtherUNITED CONCORDIA
96767OtherBCBS CFNC
T63895Medicare UPIN