Provider Demographics
NPI:1386059103
Name:PEDERSEN, ANNE (DDS)
Entity type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 S MILLER ST STE J
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-6915
Mailing Address - Country:US
Mailing Address - Phone:805-922-9626
Mailing Address - Fax:
Practice Address - Street 1:1414 S MILLER ST STE 8
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-6961
Practice Address - Country:US
Practice Address - Phone:805-345-3702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2021-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1021171223P0221X
WADE606541861223P0221X
WADERE.RR.60453869122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223P0221XDental ProvidersDentistPediatric Dentistry