Healthcare Provider Details

I. General information

NPI: 1730001298
Provider Name (Legal Business Name): EMILY PEARSON
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 GOODMAN RD E # A
SOUTHAVEN MS
38671-9530
US

IV. Provider business mailing address

2172 LAUGHTER RD N
NESBIT MS
38651-8904
US

V. Phone/Fax

Practice location:
  • Phone: 662-349-2351
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number112796
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: