Provider Demographics
NPI:1649566241
Name:PEDERSEN, ESTHER (DDS)
Entity Type:Individual
Prefix:DR
First Name:ESTHER
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 1:10925 ANTIOCH RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2146
Mailing Address - Country:US
Mailing Address - Phone:913-491-1200
Mailing Address - Fax:
Practice Address - Street 1:10925 ANTIOCH RD
Practice Address - Street 2:SUITE 201
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2146
Practice Address - Country:US
Practice Address - Phone:913-491-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60806122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist