Provider Demographics
NPI:1235200049
Name:PEARSON, JARED DON (DDS)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:DON
Last Name:PEARSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8030 N CALDWELL AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64152-1608
Mailing Address - Country:US
Mailing Address - Phone:801-602-9595
Mailing Address - Fax:
Practice Address - Street 1:8030 N CALDWELL AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64152-1608
Practice Address - Country:US
Practice Address - Phone:801-602-9595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20210416451223P0221X
UT5279193-99221223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty