Healthcare Provider Details

I. General information

NPI: 1033517909
Provider Name (Legal Business Name): MELVIN H PEARSON, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2014
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3436 RICHMOND AVE
STATEN ISLAND NY
10312-3227
US

IV. Provider business mailing address

3436 RICHMOND AVE
STATEN ISLAND NY
10312-3227
US

V. Phone/Fax

Practice location:
  • Phone: 718-948-5100
  • Fax:
Mailing address:
  • Phone: 718-948-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. MELVIN HENRY PEARSON
Title or Position: ORTHODONTIST
Credential: D.D.S.
Phone: 718-948-5100