Provider Demographics
NPI:1063659514
Name:PEARSON, WAYNE ALAN (DDS)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:ALAN
Last Name:PEARSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8340 MORRO RD
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-3927
Mailing Address - Country:US
Mailing Address - Phone:805-461-1000
Mailing Address - Fax:805-461-1049
Practice Address - Street 1:8340 MORRO RD
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-3927
Practice Address - Country:US
Practice Address - Phone:805-461-1000
Practice Address - Fax:805-461-1049
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29416122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist