Provider Demographics
NPI:1164699864
Name:PEARSON, MARILYN (DDS)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
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 1:38 BLANDING BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2282
Mailing Address - Country:US
Mailing Address - Phone:904-272-9440
Mailing Address - Fax:904-272-0720
Practice Address - Street 1:38 BLANDING BLVD STE A
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-2282
Practice Address - Country:US
Practice Address - Phone:904-272-9440
Practice Address - Fax:904-272-0720
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN69451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice