Organization
JAC W. PEDERSEN II, D.D.S., INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAC W. PEDERSEN II (OWNER)
(805) 544-8111
Entity
Organization
Contact information
Practice address
620 CALIFORNIA BLVD STE H, SAN LUIS OBISPO, CA 93401-2500
(805) 544-8111
(805) 544-6309
Mailing address
620 CALIFORNIA BLVD STE H, SAN LUIS OBISPO, CA 93401-2500
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
27472
CA
Other
Enumeration date
11/01/2006
Last updated
08/22/2020
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