Jerry R Pearson, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D5104 Issued in AZ

Practice address

1904 W Parkside LN
Suite 201
Phoenix, AZ 85027-1228

Phone

(623) 434-9343

Fax

(623) 321-6268

NPI assigned

Jul 25, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1639192545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8104 N. 110TH PLACE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85020",
            "telephone_number": "623-434-9343",
            "fax_number": "623-321-6268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1904 W PARKSIDE LN",
            "address_2": "SUITE 201",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850271228",
            "telephone_number": "623-434-9343",
            "fax_number": "623-321-6268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEARSON",
        "first_name": "JERRY",
        "middle_name": "R",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D5104",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "612938",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pearson Eyecare Group, LLC
• Caleb Mark Pearson, PSY.D.
• David Gregory Pearson, MD
• Erica Denise Pearson, LMSW
• Erik Pearson
• Jocelyn Pearson, RN
• Joe Wilson Pearson, D.D.S.
• Logan Pearson
• Mark Pearson
• Mary Jessica Pearson, MD

• General Practice Dentistry in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.