Provider Demographics
NPI:1528046059
Name:PEARSON, MELVIN HENRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:HENRY
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 1:3436 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-3227
Mailing Address - Country:US
Mailing Address - Phone:718-948-5100
Mailing Address - Fax:718-967-2253
Practice Address - Street 1:3436 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-3227
Practice Address - Country:US
Practice Address - Phone:718-948-5100
Practice Address - Fax:718-967-2253
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027094-011223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics