Provider Demographics
NPI:1023188455
Name:VICTORIA S. PEDOEEM, DDS
Entity Type:Organization
Organization Name:VICTORIA S. PEDOEEM, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:PEDOEEM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-217-9670
Mailing Address - Street 1:3426 KENNEDY BLVD.
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307
Mailing Address - Country:US
Mailing Address - Phone:201-217-9670
Mailing Address - Fax:201-217-9671
Practice Address - Street 1:3426 KENNEDY BLVD.
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307
Practice Address - Country:US
Practice Address - Phone:201-217-9670
Practice Address - Fax:201-217-9671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI169971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2105501Medicaid