Provider Demographics
NPI:1427048396
Name:PEARSON, ERIC ROLAND (DDS)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:ROLAND
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 1:804 KENYON RD
Mailing Address - Street 2:STE 120
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5742
Mailing Address - Country:US
Mailing Address - Phone:515-576-8727
Mailing Address - Fax:515-576-7076
Practice Address - Street 1:804 KENYON RD
Practice Address - Street 2:STE 120
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5742
Practice Address - Country:US
Practice Address - Phone:515-576-8727
Practice Address - Fax:515-576-7076
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA073271223S0112X
WI1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1095471Medicaid
I11942Medicare PIN
IA1095471Medicaid