Provider Demographics
NPI:1891764635
Name:PEARCE, MARK MARSHALL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:MARSHALL
Last Name:PEARCE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6601 LYNDALE AVE S
Mailing Address - Street 2:WOODLAKE CENTRE SUITE 230
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-2477
Mailing Address - Country:US
Mailing Address - Phone:612-866-1234
Mailing Address - Fax:612-638-1232
Practice Address - Street 1:6601 LYNDALE AVE S
Practice Address - Street 2:WOODLAKE CENTRE SUITE 230
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2477
Practice Address - Country:US
Practice Address - Phone:612-866-1234
Practice Address - Fax:612-638-1232
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND10320122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist