Jac W Pedersen II, D.D.S.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

27472 Issued in CA

Practice address

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

Phone

(805) 544-8111

Fax

(805) 544-6309

NPI assigned

Oct 21, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jac W Pedersen II DDS

  • Pediatric Dentistry
  • San Luis Obispo, CA
  • NPI 1407014541
  NPD (past) Authorized official

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

{
    "created_epoch": "1224547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1224547200000",
    "number": "1952553091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3221 S HIGUERA ST",
            "address_2": "STE. 100",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934016924",
            "telephone_number": "805-544-8111",
            "fax_number": "805-544-6309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3221 S HIGUERA ST",
            "address_2": "STE. 100",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934016924",
            "telephone_number": "805-544-8111",
            "fax_number": "805-544-6309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSEN",
        "first_name": "JAC",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-10-21",
        "last_updated": "2008-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "27472",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taryn Alexandra Pearl
• Michael Pearson
• Margaret Grace Peavy, LCSW
• Madeleine Pechner
• Carl Curtis Peck, M.D.
• Sarah Pedersen, MA, RBT, BCBA
• Pediatric Physical Therapy & Services, Inc.
• Jacob Pedler
• Christopher R Peinado, MD
• Michelle Pellegrin

• 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 Oct 21, 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.