Provider Demographics
NPI:1184816431
Name:PEARLINE, DDS & ROACH, DMD, PC
Entity Type:Organization
Organization Name:PEARLINE, DDS & ROACH, DMD, PC
Other - Org Name:WEST COUNTY ENDODONTICS, LTD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RODRICK
Authorized Official - Middle Name:EVAN
Authorized Official - Last Name:PEARLINE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:314-991-5850
Mailing Address - Street 1:777 S NEW BALLAS RD STE 201W
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8717
Mailing Address - Country:US
Mailing Address - Phone:314-991-5859
Mailing Address - Fax:314-991-1896
Practice Address - Street 1:777 S NEW BALLAS RD STE 201W
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8717
Practice Address - Country:US
Practice Address - Phone:314-991-5859
Practice Address - Fax:314-991-1896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0129271223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty