| NPI | 1194803049 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAC W. PEDERSEN Owner 805-544-8111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 27472) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2020-08-22 |