Provider Demographics
NPI:1215010467
Name:CORSI HOEY PEARSON DDS INC
Entity Type:Organization
Organization Name:CORSI HOEY PEARSON DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:KENYON
Authorized Official - Last Name:SCARR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-584-1630
Mailing Address - Street 1:1350 MEDICAL CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928
Mailing Address - Country:US
Mailing Address - Phone:707-584-1630
Mailing Address - Fax:707-584-2394
Practice Address - Street 1:1350 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928
Practice Address - Country:US
Practice Address - Phone:707-584-1630
Practice Address - Fax:707-584-2394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA257621223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty