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Individual
DR. KENNETH WAYNE PIERSON
Active
Individual
DR. KENNETH WAYNE PIERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MPH
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
22015
CA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
GA1045
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000222015CA
DELTA DENTAL OF CA
CA
01
—
B22015-01
DENTI-CAL PROVIDER ID
CA
Enumeration date
07/25/2006
Last updated
10/15/2012
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