| Jac W. Pedersen Ii, D.d.s., Inc | |
|
620 California Blvd Ste H San Luis Obispo CA 93401-2500 | |
| (805) 544-8111 | |
| (805) 544-6309 |
| Full Name | Jac W. Pedersen Ii, D.d.s., Inc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 620 California Blvd Ste H, San Luis Obispo, California |
| Authorized Official Name and Position | Jac W. Pedersen (OWNER) |
| Authorized Official Contact | 8055448111 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jac W. Pedersen Ii, D.d.s., Inc 620 California Blvd Ste H San Luis Obispo CA 93401-2500 Ph: () - | Jac W. Pedersen Ii, D.d.s., Inc 620 California Blvd Ste H San Luis Obispo CA 93401-2500 Ph: (805) 544-8111 |
| NPI Number | 1194803049 |
|---|---|
| Provider Enumeration Date | 11/01/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194803049 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 27472 (California) | Primary |
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