Organization
PEDERSEN DENTAL GROUP LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FONDA R PEDERSEN D.D.S. (PRESIDENT)
(773) 544-3512
Entity
Organization
Contact information
Practice address
6044 N AVONDALE AVE, CHICAGO, IL 60631-3114
(773) 544-3512
(773) 887-5802
Mailing address
6044 N AVONDALE AVE, CHICAGO, IL 60631-3114
(773) 544-3512
(773) 887-5802
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019021209
IL
Other
Enumeration date
08/03/2012
Last updated
08/03/2012
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