Individual
JERRY R PEARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1904 W PARKSIDE LN, SUITE 201, PHOENIX, AZ 85027-1228
(623) 434-9343
(623) 321-6268
Mailing address
8104 N. 110TH PLACE, PHOENIX, AZ 85020
(623) 434-9343
(623) 321-6268
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D5104
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
612938
—
AZ
Enumeration date
07/25/2006
Last updated
07/08/2007
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