Provider Demographics
NPI:1679643738
Name:ACKERMAN, RICHARD J JR (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:ACKERMAN
Suffix:JR
Gender:M
Credentials:DDS MS
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Mailing Address - Street 1:705 FIRST AVENUE
Mailing Address - Street 2:SUITE B
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801
Mailing Address - Country:US
Mailing Address - Phone:620-227-2234
Mailing Address - Fax:620-227-8084
Practice Address - Street 1:705 FIRST AVENUE
Practice Address - Street 2:SUITE B
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801
Practice Address - Country:US
Practice Address - Phone:620-227-2234
Practice Address - Fax:620-227-8084
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS43821223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
743832OtherUNITED CONCORDIA
KS59637OtherBLUE CROSS BLUE SHIELD