Mission Pediatric Dentistry

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

MISSION PEDIATRIC DENTISTRY

Practice address

27800 Medical Center Rd Ste 332
Mission Viejo, CA 92691-6409

Phone

(949) 364-1141

NPI assigned

Jan 26, 2007

Organization subpart

No

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

Authorized official

Name

Pedersen John, D.D.S.

Title

Owner

Phone

(949) 364-1171

Specialties & licenses 2

Addresses

Tax ID family

Culver Westside Dental Group2 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.

• John Pedersen D D S Inc

  • General Practice Dentistry
  • Los Angeles, CA
  • NPI 1811180995
  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.

• Andrew Chang

  • Pediatric Dentistry
  • Mission Viejo, CA
  • NPI 1083992994
  NPD (past)

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189641600000",
    "number": "1629124128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27800 MEDICAL CENTER RD STE 332",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926916409",
            "telephone_number": "949-364-1141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27800 MEDICAL CENTER RD STE 332",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926916409",
            "telephone_number": "949-364-1141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSION PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "last_updated": "2007-09-13",
        "status": "A",
        "authorized_official_last_name": "JOHN",
        "authorized_official_first_name": "PEDERSEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "949-364-1171",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mission Internal Medical Group, Inc.
• Mission Internal Medical Group, Inc.
• Mission Internal Medical Group, Inc.
• Mission Medical Urgent Care
• Mission Pathology Medical Associates
• Mission Pediatric Med CL
• Mission Pediatric Medical Clinic, Inc.
• Mission Toxicology, LLC
• Mission Trauma Surgical Medical GRP
• Mission Viejo Assisted Living LLC

• Pediatric Dentistry in Mission Viejo, CA
• Providers in Mission Viejo, CA by specialty
• Pediatric Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2007; 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.