Provider Demographics
NPI:1245252188
Name:G. GEORGE PEARSON, DMD & CRAIG B. THEURER, DDS, P.C.
Entity type:Organization
Organization Name:G. GEORGE PEARSON, DMD & CRAIG B. THEURER, DDS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-487-5805
Mailing Address - Street 1:1955 S 1300 E
Mailing Address - Street 2:L-1
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-3638
Mailing Address - Country:US
Mailing Address - Phone:801-487-5805
Mailing Address - Fax:801-487-3415
Practice Address - Street 1:1955 S 1300 E
Practice Address - Street 2:L-1
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-3638
Practice Address - Country:US
Practice Address - Phone:801-487-5805
Practice Address - Fax:801-487-3415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT136058 & 1383261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty