1134420359 NPI number — DR. CRYSTAL ANN EDMISTER PIERSON D.D.S.

Table of content: DR. CRYSTAL ANN EDMISTER PIERSON D.D.S. (NPI 1134420359)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134420359 NPI number — DR. CRYSTAL ANN EDMISTER PIERSON D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PIERSON
Provider First Name:
CRYSTAL
Provider Middle Name:
ANN EDMISTER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EDMISTER
Provider Other First Name:
CRYSTAL
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134420359
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 500169
Provider Second Line Business Mailing Address:
SAIPAN SEVENTH-DAY ADVENTIST CLINIC
Provider Business Mailing Address City Name:
SAIPAN
Provider Business Mailing Address State Name:
MP
Provider Business Mailing Address Postal Code:
96950
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
670-234-6008
Provider Business Mailing Address Fax Number:
670-234-0521

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CLINIC1 QUARTERMASTER RD
Provider Second Line Business Practice Location Address:
SAIPAN SEVENTH-DAY ADVENTIST CLINIC
Provider Business Practice Location Address City Name:
SAIPAN
Provider Business Practice Location Address State Name:
MP
Provider Business Practice Location Address Postal Code:
96950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
670-234-6008
Provider Business Practice Location Address Fax Number:
670-234-0521
Provider Enumeration Date:
11/04/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  0094 , registered in the state of MP ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 122300000X , with the licence number: DN17337 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)