DR. JAC W PEDERSEN II D.D.S.
NPI 1952553091
Dentist - Pediatric Dentistry in San Luis Obispo, CA

Q: What is Jac Pedersen's NPI number?

The NPI number for Jac Pedersen is 1952553091. It was assigned to this individual provider in the NPPES registry on October 21, 2008.

Q: What is Jac Pedersen's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Jac Pedersen was last updated on October 21, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 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.

Active since October 21, 2008

3221 S HIGUERA ST, STE. 100, SAN LUIS OBISPO, CA 93401(805) 544-8111(805) 544-6309 Get Directions Write a Review

NPPES record last updated: October 21, 2008. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Dr. Jac W Pedersen Ii D.d.s. NPPES

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

DR. JAC W PEDERSEN II D.D.S. (NPI 1952553091) is an individual pediatric dentistry provider in San Luis Obispo, California, licensed in California (27472) and active in the NPI registry since October 2008.

NPPES Registry Identity

NPI1952553091

Entity TypeIndividualMale

Primary Taxonomy1223P0221X

Provider Legal NameDR. JAC W PEDERSEN IICredential: D.D.S.

Location Address3221 S HIGUERA ST, STE. 100San Luis Obispo, CA 93401-6924

Mailing Address3221 S Higuera St, Ste. 100San Luis Obispo, CA 93401-6924 · (805) 544-8111 · Fax (805) 544-6309

Phone(805) 544-8111

Fax(805) 544-6309

Sole ProprietorYes

Enumeration DateOctober 21, 2008

✔ NPI 1952553091 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.

3221 S HIGUERA ST, San Luis Obispo, CA 93401

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Other Providers at the Same Location NPPES 3

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

VIKRAM R. TIKU, DDS, INC.

Dentist (Pediatric Dentistry)

3221 S HIGUERA ST
SAN LUIS OBISPO, CA 93401

San Luis Obispo County (805) 544-8111

DR. VIKRAM RAJ TIKU DDS

Dentist (Pediatric Dentistry)

3221 S HIGUERA ST
SAN LUIS OBISPO, CA 93401

San Luis Obispo County (805) 544-8111

DR. ROSALYN LIM CHA DDS

Dentist

3221 S HIGUERA ST
SAN LUIS OBISPO, CA 93401

San Luis Obispo County (805) 544-8111

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 Pedersen's NPI number?

The NPI number for Jac Pedersen is 1952553091. It was assigned to this individual provider in the NPPES registry on October 21, 2008.

Where is Jac Pedersen located?

Jac Pedersen practices at 3221 S Higuera St Ste. 100, San Luis Obispo, CA 93401. The listed phone number is (805) 544-8111.

What is Jac Pedersen'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 Pedersen was last updated on October 21, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 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.