Healthcare Provider Details

I. General information

NPI: 1235200049
Provider Name (Legal Business Name): JARED DON PEARSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8030 N CALDWELL AVE
KANSAS CITY MO
64152-1608
US

IV. Provider business mailing address

8030 N CALDWELL AVE
KANSAS CITY MO
64152-1608
US

V. Phone/Fax

Practice location:
  • Phone: 801-602-9595
  • Fax:
Mailing address:
  • Phone: 801-602-9595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2021041645
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number5279193-9922
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: