Provider Demographics
NPI:1740490234
Name:PEARSON, GENERAL RAYMOND JR (DDS)
Entity type:Individual
Prefix:DR
First Name:GENERAL
Middle Name:RAYMOND
Last Name:PEARSON
Suffix:JR
Gender:M
Credentials:DDS
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Mailing Address - Street 1:10837 LAUREL STREET
Mailing Address - Street 2:#201
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730
Mailing Address - Country:US
Mailing Address - Phone:909-214-3965
Mailing Address - Fax:909-941-3851
Practice Address - Street 1:10837 LAUREL STREET
Practice Address - Street 2:#201
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730
Practice Address - Country:US
Practice Address - Phone:909-214-3965
Practice Address - Fax:909-941-3851
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2022-04-29
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Provider Licenses
StateLicense IDTaxonomies
CA0208941223G0001X
CA252831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice