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General NPI Number Information
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NPI Number | 1366982514
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Entity Type | Individual
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Provider Name | CHRISTOPHER J PEARCE D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 03/06/2017
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Last Update Date | 01/19/2018
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Provider Practice Location Address
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Address Line | 3434 E WASHINGTON AVE
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City | MADISON
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State | WI
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Zip | 53704-4155
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Country | US
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Telephone | 608-443-5482
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Fax |
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Provider Business Mailing Address
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Address Line | 2901 W BELTLINE HWY STE 120
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City | MADISON
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State | WI
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Zip | 53713-4231
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Country | US
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Telephone |
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Fax |
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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 | DE60693945
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License Number State | WA
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