Jac W Pedersen II DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

27472 Issued in CA

Legal business name

JAC W PEDERSEN II DDS

Practice address

3221 S Higuera St Ste 100
San Luis Obispo, CA 93401-6924

Phone

(805) 544-8111

Fax

(805) 544-6309

NPI assigned

May 27, 2008

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, D.D.S., Inc

  • Pediatric Dentistry
  • San Luis Obispo, CA
  • NPI 1194803049
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jac W Pedersen II, D.D.S.

  • Pediatric Dentistry
  • San Luis Obispo, CA
  • NPI 1952553091
  NPD (past) Authorized official

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

{
    "created_epoch": "1211846400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211846400000",
    "number": "1407014541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3221 S HIGUERA ST STE 100",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934016924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3221 S HIGUERA ST STE 100",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934016924",
            "telephone_number": "805-544-8111",
            "fax_number": "805-544-6309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAC W PEDERSEN II DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-27",
        "last_updated": "2008-05-27",
        "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": []
}

• Gibar Iturbide Colin
• Alex Joseph Iversen
• J Trees Ritter D.O., Inc.
• J Trees Ritter, DO, Inc.
• J. Dustin Bernard, D.O., Medical Corporation
• Jac W. Pedersen II, D.D.S., Inc
• Sarah Jackson
• Ava Blue Jacobsen
• Eric J. Jacobsen, M.D.
• Benjamin Jacobson

• 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 May 27, 2008; 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.