Provider Demographics
NPI:1346382942
Name:ACKERMANN, RICHARD J (DMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:ACKERMANN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 636
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:KY
Mailing Address - Zip Code:41095
Mailing Address - Country:US
Mailing Address - Phone:859-567-5851
Mailing Address - Fax:859-567-5191
Practice Address - Street 1:100 W HIGH ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:KY
Practice Address - Zip Code:41095
Practice Address - Country:US
Practice Address - Phone:859-567-5851
Practice Address - Fax:859-567-5191
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6190122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist