Pedersen Dental Group LTD.

Primary specialty

DentistTaxonomy code 122300000X

License

019021209 Issued in IL

Legal business name

PEDERSEN DENTAL GROUP LTD.

Practice address

6044 N Avondale Ave
Chicago, IL 60631-3114

Phone

(773) 544-3512

Fax

(773) 887-5802

NPI assigned

Aug 3, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Fonda R Pedersen, D.D.S.

Title

President

Phone

(773) 544-3512

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1343952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343952000000",
    "number": "1841547270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6044 N AVONDALE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606313114",
            "telephone_number": "773-544-3512",
            "fax_number": "773-887-5802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6044 N AVONDALE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606313114",
            "telephone_number": "773-544-3512",
            "fax_number": "773-887-5802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDERSEN DENTAL GROUP LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-03",
        "last_updated": "2012-08-03",
        "status": "A",
        "authorized_official_last_name": "PEDERSEN",
        "authorized_official_first_name": "FONDA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-544-3512",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019021209",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lori Jo Peculis
• Shilpa Pedapati, M.D
• Radhika Peddinti
• Laura L Pedelty, PHD, MD
• Janet S Peden, PHD
• Cameron Joseph Pedersen, MD
• Fonda R Pedersen, D.D.S.
• Jessica Pedersen, OTR
• Kara Pedersen, RN, FNP-BC
• Kyle James Pedersen

• Dentist in Chicago, IL
• Providers in Chicago, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2012; 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.