OrganizationActive
Jac W. Pedersen II, D.D.S., Inc
NPI 1194803049 · Pediatric Dentistry · San Luis Obispo, CA
Jac W. Pedersen II, D.D.S., Inc is a Pediatric Dentistry organization in San Luis Obispo, CA (NPI 1194803049).
Provider details
- NPI number
- 1194803049
- Entity type
- Organization
- Primary specialty
- Pediatric DentistryDental Providers
- Organization subpart
- No
- Authorized official
- Jac Pedersen, Owner(805) 544-8111
- License
- 27472 (CA)
Specialties & taxonomies
Dental Providers
Profile Score
Detailed profile(90/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
620 California Blvd Ste H
San Luis Obispo, CA 93401-2500
Phone: (805) 544-8111
Fax: (805) 544-6309
Street-level locationGet directions
Mailing address
620 California Blvd Ste H
San Luis Obispo, CA 93401-2500
Registry dates
- Enumerated
- 2006-11-01
- Last updated
- 2020-08-22
Frequently asked questions
- What is Jac W. Pedersen II, D.D.S., Inc's NPI number?
- Jac W. Pedersen II, D.D.S., Inc's National Provider Identifier (NPI) is 1194803049, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Jac W. Pedersen II, D.D.S., Inc?
- Jac W. Pedersen II, D.D.S., Inc is classified in the NPPES registry as Pediatric Dentistry (Dental Providers).
- Where is Jac W. Pedersen II, D.D.S., Inc located?
- Jac W. Pedersen II, D.D.S., Inc's practice location on file with NPPES is 620 California Blvd Ste H, San Luis Obispo, CA 93401-2500.
- What is Jac W. Pedersen II, D.D.S., Inc's phone number?
- The practice phone number listed in the NPPES registry for Jac W. Pedersen II, D.D.S., Inc is (805) 544-8111.
- Who is the authorized official for Jac W. Pedersen II, D.D.S., Inc?
- The authorized official listed on Jac W. Pedersen II, D.D.S., Inc's NPPES record is Jac Pedersen, Owner. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Jac W. Pedersen II, D.D.S., Inc's NPI active?
- Yes — Jac W. Pedersen II, D.D.S., Inc's NPI (1194803049) is active in the NPPES registry as of the last update on 2020-08-22.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.