Provider Demographics
NPI:1831314624
Name:KARLSGODT, PEAR WILLIAM (PEAR KARLSGODT)
Entity Type:Individual
Prefix:DR
First Name:PEAR
Middle Name:WILLIAM
Last Name:KARLSGODT
Suffix:
Gender:M
Credentials:PEAR KARLSGODT
Other - Prefix:DR
Other - First Name:PEAR
Other - Middle Name:WILLIAM
Other - Last Name:KARLSGODT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PEAR KARLSGODT
Mailing Address - Street 1:5302 VALLE VIS
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-4259
Mailing Address - Country:US
Mailing Address - Phone:619-464-3331
Mailing Address - Fax:619-464-0534
Practice Address - Street 1:8419 LA MESA BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-5381
Practice Address - Country:US
Practice Address - Phone:619-464-3191
Practice Address - Fax:619-464-0534
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA249921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice