Auburn Ny Pedersen Dental, PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

AUBURN NY PEDERSEN DENTAL, PLLC

Doing business as

CK Family Dental

Practice address

33 William St Ste 1
Auburn, NY 13021-3730

Phone

(315) 253-8891

NPI assigned

Feb 16, 2023

Last updated

Feb 16, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Todd Pedersen, DDSNPI 1215316583

Title

Owner

Phone

(585) 469-5433

Specialties & licenses 1

Addresses

Other names 1

• CK Family Dental Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Todd Richard Pedersen, D.D.S.

  • Student in an Organized Health Care Education/Training Program
  • Rochester, NY
  • NPI 1215316583
  NPD Authorized official
• Theresa Anne Casper-Klock, DDS

  • General Practice Dentistry
  • Auburn, NY
  • NPI 1013911502
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1676505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676505600000",
    "number": "1003514332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 WILLIAM ST STE 1",
            "city": "AUBURN",
            "state": "NY",
            "postal_code": "130213730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 WILLIAM ST STE 1",
            "city": "AUBURN",
            "state": "NY",
            "postal_code": "130213730",
            "telephone_number": "315-253-8891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUBURN NY PEDERSEN DENTAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-16",
        "last_updated": "2023-02-16",
        "certification_date": "2023-02-16",
        "status": "A",
        "authorized_official_last_name": "PEDERSEN",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "585-469-5433",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CK Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Auburn Memorial Hospital
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• Auburn Memorial Medical Services, PC
• Auburn Memorial Medical Services, PC (Auburn Orthopaedic Services)
• Auburn Ny Oral Surgery PLLC
• Auburn Orthopaedic Specialists
• Auburn Pathology Associates, PC
• Auburn Pediatrics PLLC
• Auburn Radiologic Associates
• Auburn Radiologic Associates PC

• Dental Clinic/Center in Auburn, NY
• Providers in Auburn, NY by specialty
• Dental Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.