Provider Demographics
NPI:1588634190
Name:MAECHTLEN, RODGER L (DDS)
Entity Type:Individual
Prefix:
First Name:RODGER
Middle Name:L
Last Name:MAECHTLEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 E CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:ARKANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67005-8538
Mailing Address - Country:US
Mailing Address - Phone:620-442-3719
Mailing Address - Fax:
Practice Address - Street 1:2508 EDGEMONT DR
Practice Address - Street 2:
Practice Address - City:ARKANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:67005-3844
Practice Address - Country:US
Practice Address - Phone:620-442-2040
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS46131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice