Provider Demographics
NPI:1942361852
Name:PEARSON, JOHN DONALD JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DONALD
Last Name:PEARSON
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:D
Other - Last Name:PEARSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1730 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-7302
Mailing Address - Country:US
Mailing Address - Phone:916-482-1688
Mailing Address - Fax:916-482-4691
Practice Address - Street 1:1730 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-7302
Practice Address - Country:US
Practice Address - Phone:916-482-1688
Practice Address - Fax:916-482-4691
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD19660122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist