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General NPI Number Information
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NPI Number | 1811180995
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Entity Type | Organization
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Legal Business Name | JOHN PEDERSEN D D S INC
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Dates
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Enumeration Date | 08/22/2007
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Last Update Date | 08/22/2007
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Provider Practice Location Address
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Address Line | 12504 W WASHINGTON BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90066-5506
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Country | US
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Telephone | 310-390-6272
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Fax | 310-390-6674
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Provider Business Mailing Address
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Address Line | 12504 W WASHINGTON BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90066-5506
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Country | US
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Telephone | 310-390-6272
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Fax | 310-390-6674
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. LOIS EVANS
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Credential |
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Telephone | 310-390-6272
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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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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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