Individual
TATE PEARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1724 NEBRASKA AVE BLDG 1608, FORT LEONARD WOOD, MO 65473-8939
(573) 596-0417
Mailing address
1724 NEBRASKA AVE BLDG 1608, FORT LEONARD WOOD, MO 65473-8939
(573) 596-0417
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DEN-DEN-LIC-28380
MT
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
05/08/2023
Last updated
08/19/2025
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