Provider Demographics
NPI:1366678377
Name:PIERSON, DUSTIN R (DO)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:R
Last Name:PIERSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7124 KNIGHTDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-9265
Mailing Address - Country:US
Mailing Address - Phone:919-266-6211
Mailing Address - Fax:919-350-9824
Practice Address - Street 1:7124 KNIGHTDALE BLVD
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-9265
Practice Address - Country:US
Practice Address - Phone:919-266-6211
Practice Address - Fax:919-350-9824
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
NC2011-00677207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program