Provider Demographics
NPI:1720171499
Name:STANLEY PEARLSON DMD, PC
Entity Type:Organization
Organization Name:STANLEY PEARLSON DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-647-9536
Mailing Address - Street 1:361 EAST CENTER STREET
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4445
Mailing Address - Country:US
Mailing Address - Phone:860-647-9536
Mailing Address - Fax:
Practice Address - Street 1:361 EAST CENTER STREET
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4445
Practice Address - Country:US
Practice Address - Phone:860-647-9536
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT38711223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty