Healthcare Provider Details

I. General information

NPI: 1689898850
Provider Name (Legal Business Name): KENNETH E PEARSON DDS PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12921 CANTRELL RD SUITE 200
LITTLE ROCK AR
72223
US

IV. Provider business mailing address

12921 CANTRELL RD SUITE 200
LITTLE ROCK AR
72223
US

V. Phone/Fax

Practice location:
  • Phone: 501-221-1200
  • Fax: 501-221-1326
Mailing address:
  • Phone: 501-221-1200
  • Fax: 501-221-1326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2694
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: