Provider Demographics
NPI:1699810424
Name:PEARSON, ROBERT
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:PEARSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 TOWN CENTER AVENUE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024
Mailing Address - Country:US
Mailing Address - Phone:678-835-0793
Mailing Address - Fax:678-546-7932
Practice Address - Street 1:350 TOWN CENTER AVENUE
Practice Address - Street 2:SUITE 301
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-9412
Practice Address - Country:US
Practice Address - Phone:678-835-0793
Practice Address - Fax:850-837-2042
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA89021223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics