Provider Demographics
NPI:1881787125
Name:PIERSON, DIANNE RENEE (DDS)
Entity type:Individual
Prefix:DR
First Name:DIANNE
Middle Name:RENEE
Last Name:PIERSON
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 1:1503 MOUNTAIN VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3201
Mailing Address - Country:US
Mailing Address - Phone:303-776-7804
Mailing Address - Fax:303-774-6530
Practice Address - Street 1:1503 MOUNTAIN VIEW AVE
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3201
Practice Address - Country:US
Practice Address - Phone:303-776-7804
Practice Address - Fax:303-774-6530
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN88441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO25983521Medicaid