Provider Demographics
NPI:1407985757
Name:PEARSON, GLENN ANTHONY (DMD)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:ANTHONY
Last Name:PEARSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10225 STIRLING RD
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328-6526
Mailing Address - Country:US
Mailing Address - Phone:954-434-5440
Mailing Address - Fax:954-434-5434
Practice Address - Street 1:10225 STIRLING RD
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33328-6526
Practice Address - Country:US
Practice Address - Phone:954-434-5440
Practice Address - Fax:954-434-5434
Is Sole Proprietor?:No
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN124571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice