Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | D1222 | MN |
NPI | 1043476054 |
---|---|
Provider Name | Dr. Andrew Graham Pearson |
First Address | Edina, MN 55435 |
Second Address | Edina, MN 55435-4534 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2008 |
Last Update Date | 03/08/2010 |