Provider Demographics
NPI:1154449585
Name:PEARSON, SUSAN MARGARET (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MARGARET
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 1:1131 UNIVERSITY BLVD W
Mailing Address - Street 2:103
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-3357
Mailing Address - Country:US
Mailing Address - Phone:301-649-2203
Mailing Address - Fax:301-649-7329
Practice Address - Street 1:1131 UNIVERSITY BLVD W
Practice Address - Street 2:103
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-3357
Practice Address - Country:US
Practice Address - Phone:301-649-2203
Practice Address - Fax:301-649-7329
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD80561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice