MEDICARE: DR. RUBERT BENJAMIN PEARCE III DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	5623	NC

General Provider Information

NPI Number	:	1356429773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUBERT BENJAMIN PEARCE III DDS

Provider Business Mailing Address
First Line	:	3112 ARENDELL ST
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-3202
Country	:	US
Telephone Number	:	252-247-5602
Fax Number	:	252-247-5604

Provider Business Practice Location Address
First Line	:	3112 ARENDELL ST
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-3202
Country	:	US
Telephone Number	:	252-247-5602
Fax Number	:	252-247-5604

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	07/08/2007

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