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General NPI Number Information
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NPI Number | 1255294211
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Entity Type | Organization
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Legal Business Name | A. PEDERSEN DENTAL CORPORATION
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Dates
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Enumeration Date | 12/06/2025
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Last Update Date | 12/06/2025
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Provider Practice Location Address
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Address Line | 4251 S HIGUERA ST STE 401
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-7714
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Country | US
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Telephone | 805-922-9626
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Fax | 805-922-9177
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Provider Business Mailing Address
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Address Line | 1414 S MILLER ST STE J
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City | SANTA MARIA
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State | CA
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Zip | 93454-6915
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Country | US
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Telephone | 805-922-9626
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Fax | 805-922-9177
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Authorized Official
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Title or Position | DENTIST
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Name | ANNE CELESTE PEDERSEN
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Credential | DDS
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Telephone | 805-922-9626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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