Provider Demographics
NPI:1730299835
Name:DRS PEARSON JEFFERSON AND CAMP PA
Entity Type:Organization
Organization Name:DRS PEARSON JEFFERSON AND CAMP PA
Other - Org Name:RALEIGH ORAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:A
Authorized Official - Last Name:JEFFERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-876-4746
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2007-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty