Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 28220 | CA |
NPI | 1073645503 |
---|---|
Provider Name | Timothy Reid Pearson |
First Address | Walnut Creek, CA 94596-4962 |
Second Address | Walnut Creek, CA 94596-4962 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2007 |
Last Update Date | 08/07/2007 |