Provider Demographics
NPI:1639814866
Name:PEARSON, CHRISTINA ANGELIQUE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:ANGELIQUE
Last Name:PEARSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9624 SW 52ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-5042
Mailing Address - Country:US
Mailing Address - Phone:541-282-4820
Mailing Address - Fax:
Practice Address - Street 1:9624 SW 52ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-5042
Practice Address - Country:US
Practice Address - Phone:541-282-4820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD115981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice