Healthcare Provider Details

I. General information

NPI: 1134420359
Provider Name (Legal Business Name): CRYSTAL ANN EDMISTER PIERSON D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRYSTAL ANN EDMISTER

II. Dates (important events)

Enumeration Date: 11/04/2010
Last Update Date: 11/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CLINIC1 QUARTERMASTER RD SAIPAN SEVENTH-DAY ADVENTIST CLINIC
SAIPAN MP
96950
US

IV. Provider business mailing address

P.O. BOX 500169 SAIPAN SEVENTH-DAY ADVENTIST CLINIC
SAIPAN MP
96950
US

V. Phone/Fax

Practice location:
  • Phone: 670-234-6008
  • Fax: 670-234-0521
Mailing address:
  • Phone: 670-234-6008
  • Fax: 670-234-0521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0094
License Number StateMP
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN17337
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: