Organization
PEDERSEN DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TODD LEROY PEDERSEN DDS (PRESIDENT)
(402) 352-5566
Entity
Organization
Contact information
Practice address
1005 A ST, SCHUYLER, NE 68661-1927
(402) 352-5566
Mailing address
1005 A ST, SCHUYLER, NE 68661-1927
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5633
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05193
BLUE CROSS BLUE SHIELD
NE
05
—
100251937-00
—
NE
Enumeration date
11/22/2006
Last updated
08/22/2020
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