Provider Demographics
NPI:1700972627
Name:PEARSON, GARY (DDS)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:PEARSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1057 N KOLB RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-1328
Mailing Address - Country:US
Mailing Address - Phone:520-290-2020
Mailing Address - Fax:520-290-2026
Practice Address - Street 1:1057 N KOLB RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-1328
Practice Address - Country:US
Practice Address - Phone:520-290-2020
Practice Address - Fax:520-290-2026
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice