Provider Demographics
NPI:1053576843
Name:PEARSON, JUSTIN BLAIR (DDS)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:BLAIR
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 1:800 ENGLEWOOD PKWY
Mailing Address - Street 2:SUITE A-201
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-7315
Mailing Address - Country:US
Mailing Address - Phone:303-744-5000
Mailing Address - Fax:
Practice Address - Street 1:800 ENGLEWOOD PKWY
Practice Address - Street 2:SUITE A-201
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-7315
Practice Address - Country:US
Practice Address - Phone:303-744-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO100121223G0001X
NC88791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice