Provider Demographics
NPI:1114033222
Name:KENNETH J PEARSON DDS INC
Entity Type:Organization
Organization Name:KENNETH J PEARSON DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-496-2930
Mailing Address - Street 1:31648 RANCHO VIEJO RD #C
Mailing Address - Street 2:
Mailing Address - City:SJC
Mailing Address - State:CA
Mailing Address - Zip Code:92675
Mailing Address - Country:US
Mailing Address - Phone:949-496-2930
Mailing Address - Fax:949-496-2962
Practice Address - Street 1:31648 RANCHO VIEJO RD #C
Practice Address - Street 2:
Practice Address - City:SJC
Practice Address - State:CA
Practice Address - Zip Code:92675
Practice Address - Country:US
Practice Address - Phone:949-496-2930
Practice Address - Fax:949-496-2962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31683122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty