Healthcare Provider Details

I. General information

NPI: 1841846086
Provider Name (Legal Business Name): MILES CHRISTIAN PEDERSEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

U.S. NMRTC OKINAWA PSC 482, BOX 1600
FPO AP
96362-1600
US

IV. Provider business mailing address

U.S. NMRTC OKINAWA PSC 482, BOX 1600
FPO AP
96362-1600
US

V. Phone/Fax

Practice location:
  • Phone: 98-971-9355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14133424-9926
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number14133424-9926
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: