Provider Demographics
NPI:1639240815
Name:ALDERMAN, BRADLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:
Last Name:ALDERMAN
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 1:1550 S CODDINGTON AVE STE F
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68522-4402
Mailing Address - Country:US
Mailing Address - Phone:402-438-5555
Mailing Address - Fax:
Practice Address - Street 1:1550 S CODDINGTON AVE STE F
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68522-4402
Practice Address - Country:US
Practice Address - Phone:402-438-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6483122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025116700Medicaid