Provider Demographics
NPI:1386704757
Name:PEARSON, AMBER LEA (DDS)
Entity type:Individual
Prefix:DR
First Name:AMBER
Middle Name:LEA
Last Name:PEARSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2053 UPPER SAINT DENNIS RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-2810
Mailing Address - Country:US
Mailing Address - Phone:712-260-5453
Mailing Address - Fax:
Practice Address - Street 1:9600 UPLAND LN N STE 200
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4496
Practice Address - Country:US
Practice Address - Phone:763-416-0037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND121361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN747650700Medicaid