JAC W. PEDERSEN II, D.D.S., INC
NPI 1194803049
Dentist - Pediatric Dentistry in San Luis Obispo, CA

Q: What is Jac W. Pedersen II, D.D.S., Inc's NPI number?

The NPI number for Jac W. Pedersen II, D.D.S., Inc is 1194803049. It was assigned to this organization in the NPPES registry on November 1, 2006.

Q: What is Jac W. Pedersen II, D.D.S., Inc's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

Active since November 01, 2006

620 CALIFORNIA BLVD STE H, SAN LUIS OBISPO, CA 93401(805) 544-8111(805) 544-6309 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Jac W. Pedersen Ii, D.d.s., Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JAC W. PEDERSEN II, D.D.S., INC (NPI 1194803049) is a healthcare organization registered as a pediatric dentistry in San Luis Obispo, California and active in the NPI registry since November 2006. The organization lists Jac W. Pedersen, Owner, as its authorized official.

NPPES Registry Identity

NPI1194803049

Entity TypeOrganization

Primary Taxonomy1223P0221X

Legal Business NameJAC W. PEDERSEN II, D.D.S., INC

Location Address620 CALIFORNIA BLVD STE HSan Luis Obispo, CA 93401-2500

Mailing Address620 California Blvd Ste HSan Luis Obispo, CA 93401-2500

Phone(805) 544-8111

Fax(805) 544-6309

Organization SubpartNo

Authorized OfficialJac W. PedersenOwner · (805) 544-8111

Enumeration DateNovember 1, 2006

Last NPPES UpdateAugust 22, 2020

✔ NPI 1194803049 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Pediatric DentistryDental Providers

Taxonomy Code1223P0221X

License✔ Licensed in CA · 27472

Definition

An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.

620 CALIFORNIA BLVD STE H, San Luis Obispo, CA 93401

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

FORESTER DDS INC

Dentist (Orthodontics and Dentofacial Orthopedics)

620 CALIFORNIA BLVD STE H
SAN LUIS OBISPO, CA 93401

San Luis Obispo County (805) 592-2020

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jac W. Pedersen II, D.D.S., Inc's NPI number?

The NPI number for Jac W. Pedersen II, D.D.S., Inc is 1194803049. It was assigned to this organization in the NPPES registry on November 1, 2006.

Where is Jac W. Pedersen II, D.D.S., Inc located?

Jac W. Pedersen II, D.D.S., Inc is located at 620 California Blvd Ste H, San Luis Obispo, CA 93401. The listed phone number is (805) 544-8111.

What is Jac W. Pedersen II, D.D.S., Inc's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

When was this NPI record last updated?

The NPPES record for Jac W. Pedersen II, D.D.S., Inc was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.