Jac W. Pedersen II, D.D.S., Inc

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

27472 Issued in CA

Legal business name

JAC W. PEDERSEN II, D.D.S., INC

Practice address

620 California Blvd Ste H
San Luis Obispo, CA 93401-2500

Phone

(805) 544-8111

Fax

(805) 544-6309

NPI assigned

Nov 1, 2006

Last updated

Aug 22, 2020By 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

Dr. Jac W. Pedersen IINPI 1952553091

Title

Owner

Phone

(805) 544-8111

Specialties & licenses 1

Addresses

Tax ID family

Jac W Pedersen II DDS2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Jac W Pedersen II DDS

  • Pediatric Dentistry
  • San Luis Obispo, CA
  • NPI 1407014541
  NPD tax ID

Locations

Practitioners 1

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.

• Jac W Pedersen II, D.D.S.

  • Pediatric Dentistry
  • San Luis Obispo, CA
  • NPI 1952553091
  Authorized official Same address or phone

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1194803049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 CALIFORNIA BLVD STE H",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934012500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 CALIFORNIA BLVD STE H",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934012500",
            "telephone_number": "805-544-8111",
            "fax_number": "805-544-6309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAC W. PEDERSEN II, D.D.S., INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PEDERSEN",
        "authorized_official_first_name": "JAC",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "805-544-8111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "II"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "27472",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alex Joseph Iversen
• J Dustin Bernard DO Medical Corporation
• J Trees Ritter D.O., Inc. (Mic Ca)
• J Trees Ritter, DO, Inc. (Central Coast ID Consultants)
• Jac W Pedersen II DDS
• Sarah Jackson
• Ava Blue Jacobsen
• Eric J. Jacobsen, M.D.
• Benjamin Jacobson
• Samantha Rose Jacot, FNP

• Pediatric Dentistry in San Luis Obispo, CA
• Providers in San Luis Obispo, CA by specialty
• Pediatric Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.