| Randolph C. Pearson, D.d.s., P.s. | |
|
121 W Poplar St Ste C Walla Walla WA 99362-2871 | |
| (509) 525-2850 | |
| (509) 529-6545 |
| Full Name | Randolph C. Pearson, D.d.s., P.s. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 121 W Poplar St Ste C, Walla Walla, Washington |
| Authorized Official Name and Position | Randolph C. Pearson (PRESIDENT) |
| Authorized Official Contact | 5095252850 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Randolph C. Pearson, D.d.s., P.s. 121 W Poplar St Ste C Walla Walla WA 99362-2871 Ph: (509) 525-2850 | Randolph C. Pearson, D.d.s., P.s. 121 W Poplar St Ste C Walla Walla WA 99362-2871 Ph: (509) 525-2850 |
| NPI Number | 1790706653 |
|---|---|
| Provider Enumeration Date | 07/23/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790706653 | NPI | - | NPPES |
| 5512702 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 4967 (Washington) | Primary |
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