Provider Demographics
NPI:1700070810
Name:PEARSON GRANT, LORRI A (DDS)
Entity Type:Individual
Prefix:DR
First Name:LORRI
Middle Name:A
Last Name:PEARSON GRANT
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 1:11010 S TRYON ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-0106
Mailing Address - Country:US
Mailing Address - Phone:704-587-7336
Mailing Address - Fax:704-587-7579
Practice Address - Street 1:11010 S TRYON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-0106
Practice Address - Country:US
Practice Address - Phone:704-587-7336
Practice Address - Fax:704-587-7579
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC84681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice