Provider Demographics
NPI:1912031196
Name:PEARSON, GREGORY L (DMD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:L
Last Name:PEARSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7434
Mailing Address - Country:US
Mailing Address - Phone:541-773-3422
Mailing Address - Fax:541-779-2250
Practice Address - Street 1:1123 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7434
Practice Address - Country:US
Practice Address - Phone:541-773-3422
Practice Address - Fax:541-779-2250
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD6571122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist