MEDICARE: DR. PIRKKO PEDERSEN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	7568	FL

General Provider Information

NPI Number	:	1245404235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PIRKKO PEDERSEN DDS

Provider Business Mailing Address
First Line	:	400 S DIXIE HWY
Second Line	:	SUITE #13
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-4457
Country	:	US
Telephone Number	:	561-582-1034
Fax Number	:	561-588-3066

Provider Business Practice Location Address
First Line	:	400 S DIXIE HWY
Second Line	:	SUITE #13
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-4457
Country	:	US
Telephone Number	:	561-582-1034
Fax Number	:	561-588-3066

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2008
Last Update Date	:	04/21/2008

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