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Organization
JOHN PEDERSEN D D S INC
Active
Organization
JOHN PEDERSEN D D S INC
Active
Other names
CULVER WESTSIDE DENTAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LOIS EVANS (ADMINISTRATOR)
(310) 390-6272
Entity
Organization
Contact information
Practice address
12504 W WASHINGTON BLVD, LOS ANGELES, CA 90066-5506
(310) 390-6272
(310) 390-6674
Mailing address
12504 W WASHINGTON BLVD, LOS ANGELES, CA 90066-5506
(310) 390-6272
(310) 390-6674
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0221X
Pediatric Dentistry
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
08/22/2007
Last updated
08/22/2007
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