Active NPI
Evan Pedersen, D.M.D.
- General Practice Dentistry
- Ocala, FL
National Provider Identifier
1043552516
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D20055
- Practice address
- 9401 SW Highway 200
Suite 101
Ocala, FL 34481-9612 - Phone
- (352) 873-2000
- NPI assigned
- Mar 22, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D20055 | FL | Primary |
Addresses
Primary practice location
9401 SW Highway 200
Suite 101
Ocala, FL 34481-9612
Mailing address
4900 SW 46TH CT
Apt 902
Ocala, FL 34474-6264
Phone (815) 975-8758
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D20055 | FL | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Evan Pedersen DMD, PLLC | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dental Clinic/Center
- Austin, TX
- NPI 1962110817
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1363910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1373587200000",
"number": "1043552516",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4900 SW 46TH CT",
"address_2": "APT 902",
"city": "OCALA",
"state": "FL",
"postal_code": "344746264",
"telephone_number": "815-975-8758"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9401 SW HIGHWAY 200",
"address_2": "SUITE 101",
"city": "OCALA",
"state": "FL",
"postal_code": "344819612",
"telephone_number": "352-873-2000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEDERSEN",
"first_name": "EVAN",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-03-22",
"last_updated": "2013-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "FL",
"license": "D20055",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ocala, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.