Healthcare Provider Details

I. General information

NPI: 1184777906
Provider Name (Legal Business Name): RODRICK EVAN PEARLINE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 S NEW BALLAS RD SUITE 201W
SAINT LOUIS MO
63141-8705
US

IV. Provider business mailing address

777 S NEW BALLAS RD SUITE 201W
SAINT LOUIS MO
63141-8705
US

V. Phone/Fax

Practice location:
  • Phone: 314-991-5850
  • Fax: 314-991-1896
Mailing address:
  • Phone: 314-991-5850
  • Fax: 314-991-1896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDE12927
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: