Provider Demographics
NPI:1134420359
Name:PIERSON, CRYSTAL ANN EDMISTER (DDS)
Entity type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:ANN EDMISTER
Last Name:PIERSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:ANN
Other - Last Name:EDMISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 500169
Mailing Address - Street 2:SAIPAN SEVENTH-DAY ADVENTIST CLINIC
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950
Mailing Address - Country:US
Mailing Address - Phone:670-234-6008
Mailing Address - Fax:670-234-0521
Practice Address - Street 1:CLINIC1 QUARTERMASTER RD
Practice Address - Street 2:SAIPAN SEVENTH-DAY ADVENTIST CLINIC
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950
Practice Address - Country:US
Practice Address - Phone:670-234-6008
Practice Address - Fax:670-234-0521
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MP0094122300000X
FLDN17337122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist