Provider Demographics
NPI:1689641128
Name:PEARSON, JOHN ALEXANDER (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALEXANDER
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 1:8301 BANDFORD WAY
Mailing Address - Street 2:SUITE 121
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-2767
Mailing Address - Country:US
Mailing Address - Phone:919-876-4746
Mailing Address - Fax:919-876-5071
Practice Address - Street 1:8301 BANDFORD WAY
Practice Address - Street 2:SUITE 121
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2767
Practice Address - Country:US
Practice Address - Phone:919-876-4746
Practice Address - Fax:919-876-5071
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4390122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8996764Medicaid
96764OtherBCBS
NC8996764Medicaid
T63831Medicare UPIN