Provider Demographics
NPI:1245404235
Name:PEDERSEN, PIRKKO (DDS)
Entity Type:Individual
Prefix:DR
First Name:PIRKKO
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 1:400 S DIXIE HWY
Mailing Address - Street 2:SUITE #13
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-4457
Mailing Address - Country:US
Mailing Address - Phone:561-582-1034
Mailing Address - Fax:561-588-3066
Practice Address - Street 1:400 S DIXIE HWY
Practice Address - Street 2:SUITE #13
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-4457
Practice Address - Country:US
Practice Address - Phone:561-582-1034
Practice Address - Fax:561-588-3066
Is Sole Proprietor?:No
Enumeration Date:2008-04-21
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL75681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice