John Pedersen D D S Inc

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

JOHN PEDERSEN D D S INC

Doing business as

Culver Westside Dental Group

Practice address

12504 W Washington Blvd
Los Angeles, CA 90066-5506

Phone

(310) 390-6272

Fax

(310) 390-6674

NPI assigned

Aug 22, 2007

Last updated

Aug 22, 2007By 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

Ms. Lois Evans

Title

Administrator

Phone

(310) 390-6272

Specialties & licenses 3

Addresses

Other names 1

• CULVER WESTSIDE DENTAL GROUP Doing business as

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.

• Mission Pediatric Dentistry

  • Pediatric Dentistry
  • Mission Viejo, CA
  • NPI 1629124128
  NPD tax ID

Locations

Practitioners 2

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.

• Rasool Patel II, DDS

  • Dentist
  • Los Angeles, CA
  • NPI 1508072497
  NPD (past)
• John Pedersen, DDS

  • Dentist
  • Los Angeles, CA
  • NPI 1295780922
  NPD (past)

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

{
    "created_epoch": "1187740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187740800000",
    "number": "1811180995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12504 W WASHINGTON BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900665506",
            "telephone_number": "310-390-6272",
            "fax_number": "310-390-6674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12504 W WASHINGTON BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900665506",
            "telephone_number": "310-390-6272",
            "fax_number": "310-390-6674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN PEDERSEN D D S INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-22",
        "last_updated": "2007-08-22",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "LOIS",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "310-390-6272",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CULVER WESTSIDE DENTAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• John Lee MD Sleep Center Inc
• John Little LLC
• John Oganesyan DDS., Inc (Downtown Endodontics)
• John P Kelly MD a Professional Medical Corporation (Orange County Orthopaedic Specialists)
• John P. Anderson MD, Russell M. Perry MD, and Mark a. Sharzer, AMC
• John R Chalison MD a Medical Corporation
• John Tracy Clinic (John Tracy Center)
• John W Chang MD Medical Corporation
• John Y Jacobs OD Inc (eye see optometry)
• Brian John Jr., FNP-BC

• General Practice Dentistry in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• General Practice Dentistry in California

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