Organization
JAC W PEDERSEN II DDS
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
3221 S HIGUERA ST STE 100, SAN LUIS OBISPO, CA 93401-6924
(805) 544-8111
(805) 544-6309
Mailing address
3221 S HIGUERA ST STE 100, SAN LUIS OBISPO, CA 93401-6924
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
27472
CA
Other
Enumeration date
05/27/2008
Last updated
05/27/2008
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