Provider Demographics
NPI:1972849867
Name:JOHN D. ALDERMAN DDS PA
Entity Type:Organization
Organization Name:JOHN D. ALDERMAN DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:ALDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:620-767-6744
Mailing Address - Street 1:111 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COUNCIL GROVE
Mailing Address - State:KS
Mailing Address - Zip Code:66846-1702
Mailing Address - Country:US
Mailing Address - Phone:620-767-6744
Mailing Address - Fax:620-767-6744
Practice Address - Street 1:111 W MAIN ST
Practice Address - Street 2:
Practice Address - City:COUNCIL GROVE
Practice Address - State:KS
Practice Address - Zip Code:66846-1702
Practice Address - Country:US
Practice Address - Phone:620-767-6744
Practice Address - Fax:620-767-6744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-20
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6319122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100223330AMedicaid