Randolph C. Pearson, D.D.S., P.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4967 Issued in WA

Legal business name

RANDOLPH C. PEARSON, D.D.S., P.S.

Practice address

121 W Poplar St Ste C
Walla Walla, WA 99362-2871

Phone

(509) 525-2850

Fax

(509) 529-6545

NPI assigned

Jul 23, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Randolph C. PearsonNPI 1336122852

Title

President

Phone

(509) 525-2850

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Randolph C Pearson, D.D.S.

  • General Practice Dentistry
  • Walla Walla, WA
  • NPI 1336122852
  NPD (past) Authorized official

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

{
    "created_epoch": "1153612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1790706653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 W POPLAR ST STE C",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993622871",
            "telephone_number": "509-525-2850",
            "fax_number": "509-529-6545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 W POPLAR ST STE C",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993622871",
            "telephone_number": "509-525-2850",
            "fax_number": "509-529-6545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RANDOLPH C. PEARSON, D.D.S., P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PEARSON",
        "authorized_official_first_name": "RANDOLPH",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "509-525-2850"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "4967",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5512702",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Trina Jean Ralston, RN00127773
• Alessandra Ramirez
• Melissa Marleen Ramsey, DDS
• Aaron Henry Randall, MSW
• Laurin Randle
• Albert M Randolph, MD
• Carmen Randolph, RRT, RPSGT
• Minda B Raquipiso, MOT OTR/L
• Cynthia Lynn Rasch, MD
• Alex Amma Rauchle, DDS

• General Practice Dentistry in Walla Walla, WA
• Providers in Walla Walla, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.