NPIMap

Organization Active NPI

Pedersen Dental

  • General Practice Dentistry
  • Schuyler, NE
National Provider Identifier
1750456950
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5633 Issued in NE
Legal business name
PEDERSEN DENTAL
Practice address
1005 A St
Schuyler, NE 68661-1927
Phone
(402) 352-5566
NPI assigned
Nov 22, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Todd Leroy Pedersen, DDSNPI 1740583640
Title
President
Phone
(402) 352-5566

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 5633 NE Primary

Addresses

Primary practice location

1005 A St
Schuyler, NE 68661-1927

Mailing address

1005 A St
Schuyler, NE 68661-1927

Other identifiers 2

IdentifierTypeStateIssuer
100251937-00MedicaidNE
05193OtherNEBLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory

Locations

1005 A St
Schuyler, NE 68661
Phone (402) 352-5566

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1750456950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 A ST",
            "city": "SCHUYLER",
            "state": "NE",
            "postal_code": "686611927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 A ST",
            "city": "SCHUYLER",
            "state": "NE",
            "postal_code": "686611927",
            "telephone_number": "402-352-5566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDERSEN DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PEDERSEN",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "LEROY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "402-352-5566",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NE",
            "license": "5633",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100251937-00",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "05193",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Schuyler, NE

Sources for this page

  • 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.