Provider Demographics
NPI:1376151506
Name:PEARCE, AMBER LYNNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:LYNNE
Last Name:PEARCE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MRS
Other - First Name:AMBER
Other - Middle Name:LYNNE
Other - Last Name:PEARCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:800 W WATAUGA AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6476
Mailing Address - Country:US
Mailing Address - Phone:423-544-4286
Mailing Address - Fax:
Practice Address - Street 1:208 PARKWAY BLVD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2845
Practice Address - Country:US
Practice Address - Phone:423-543-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN113201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice