Provider Demographics
NPI:1912190182
Name:PEARSON, MADELYN SARA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MADELYN
Middle Name:SARA
Last Name:PEARSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 MERIDIAN DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEW RICHMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54017-2565
Mailing Address - Country:US
Mailing Address - Phone:715-246-2111
Mailing Address - Fax:
Practice Address - Street 1:227 MERIDIAN DR
Practice Address - Street 2:SUITE 1
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017-2565
Practice Address - Country:US
Practice Address - Phone:715-246-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6173122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist