Provider Demographics
NPI:1174195093
Name:DONALD LEE PEARSON DDS DENTAL CORPORATION
Entity Type:Organization
Organization Name:DONALD LEE PEARSON DDS DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-823-7644
Mailing Address - Street 1:19737 W VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93561-8601
Mailing Address - Country:US
Mailing Address - Phone:661-823-7644
Mailing Address - Fax:661-823-8561
Practice Address - Street 1:19737 W VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-8601
Practice Address - Country:US
Practice Address - Phone:661-823-7644
Practice Address - Fax:661-823-8561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty