Provider Demographics
NPI:1427117688
Name:PEARSON AND JUSTICE DENTISTRY PARTNERSHIP
Entity type:Organization
Organization Name:PEARSON AND JUSTICE DENTISTRY PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:C
Authorized Official - Last Name:WELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-543-0700
Mailing Address - Street 1:3285 BLAZER PKWY
Mailing Address - Street 2:STE 200
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2119
Mailing Address - Country:US
Mailing Address - Phone:859-543-0700
Mailing Address - Fax:859-543-1078
Practice Address - Street 1:3285 BLAZER PKWY
Practice Address - Street 2:STE 200
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2119
Practice Address - Country:US
Practice Address - Phone:859-543-0700
Practice Address - Fax:859-543-1078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5508122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty