Provider Demographics
NPI:1831287523
Name:PEARSON, WILLIAM EDWIN (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:EDWIN
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 1:1955 E 25TH ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6461
Mailing Address - Country:US
Mailing Address - Phone:208-529-4572
Mailing Address - Fax:
Practice Address - Street 1:749 OXFORD DR
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-4203
Practice Address - Country:US
Practice Address - Phone:208-529-0420
Practice Address - Fax:208-522-7971
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD17891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice