Healthcare Provider Details

I. General information

NPI: 1215010467
Provider Name (Legal Business Name): CORSI HOEY PEARSON DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 MEDICAL CENTER DRIVE
ROHNERT PARK CA
94928
US

IV. Provider business mailing address

1350 MEDICAL CENTER DRIVE
ROHNERT PARK CA
94928
US

V. Phone/Fax

Practice location:
  • Phone: 707-584-1630
  • Fax: 707-584-2394
Mailing address:
  • Phone: 707-584-1630
  • Fax: 707-584-2394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number25762
License Number StateCA

VIII. Authorized Official

Name: DR. JON KENYON SCARR
Title or Position: PROVIDER
Credential: DDS
Phone: 707-584-1630