Provider Demographics
NPI:1346643350
Name:PEDERSEN, ANDREW (DDS, MS)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:PEDERSEN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1589 CARLISLE RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17408-4528
Mailing Address - Country:US
Mailing Address - Phone:717-764-3854
Mailing Address - Fax:
Practice Address - Street 1:1589 CARLISLE RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17408-4528
Practice Address - Country:US
Practice Address - Phone:717-764-3854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-04
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15586122300000X
PADS0412351223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist