Healthcare Provider Details

I. General information

NPI: 1538167457
Provider Name (Legal Business Name): DANIEL ELLIS PEARCY DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 W INA RD
TUCSON AZ
85704-3115
US

IV. Provider business mailing address

1320 W INA RD
TUCSON AZ
85704-3115
US

V. Phone/Fax

Practice location:
  • Phone: 520-742-1232
  • Fax: 520-742-1232
Mailing address:
  • Phone: 520-742-1232
  • Fax: 520-742-1232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number4095
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: