=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427625938
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEARCE DENTAL GROUP, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2021
-----------------------------------------------------
Last Update Date | 06/04/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 425 WALNUT ST STE 201
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45202-3939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-651-0110
-----------------------------------------------------
Fax | 513-651-9036
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 425 WALNUT ST STE 201
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45202-3939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-651-0110
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST/OWNER
-----------------------------------------------------
Name | TROY PEARCE
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 859-957-7986
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------