Healthcare Provider Details

I. General information

NPI: 1730182536
Provider Name (Legal Business Name): CRAIG EUGENE PEARCE D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5920 EVERGREEN WAY STE E
EVERETT WA
98203-6005
US

IV. Provider business mailing address

5920 EVERGREEN WAY STE E
EVERETT WA
98203-6005
US

V. Phone/Fax

Practice location:
  • Phone: 425-353-4884
  • Fax: 425-353-6197
Mailing address:
  • Phone: 425-353-4884
  • Fax: 425-353-6197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDE00007785
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: