# PEDERSEN DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750456950
- **Authorized official:** DR. TODD LEROY PEDERSEN DDS (PRESIDENT)
- **Authorized official phone:** (402) 352-5566

## Contact information

- **Practice address:** 1005 A ST, SCHUYLER, NE 68661-1927
- **Practice address phone:** (402) 352-5566
- **Mailing address:** 1005 A ST, SCHUYLER, NE 68661-1927

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 5633 | NE | Yes |

## Other

- **Enumeration date:** 11/22/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 05193 | BLUE CROSS BLUE SHIELD | NE |
| 05 | — | 100251937-00 | — | NE |