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General NPI Number Information
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NPI Number | 1073732582
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Entity Type | Individual
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Provider Name | SHAYNA ROCHELLE PEARSON D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 10/09/2013
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Provider Practice Location Address
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Address Line | 2569 6 1/2 AVE
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City | MONROE
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State | WI
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Zip | 53566-3203
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Country | US
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Telephone | 608-328-8228
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Fax | 608-328-8230
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Provider Business Mailing Address
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Address Line | 2569 6 1/2 AVE
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City | MONROE
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State | WI
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Zip | 53566-3203
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Country | US
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Telephone | 608-328-8228
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Fax | 608-328-8230
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5917-015
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License Number State | WI
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